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MOUTH  HYGIENE 

AND 

MOUTH  SEPSIS 


operative 
Dentistry 

By  JOHN  S.  MARSHALL,  M.D.,  ScD. 

Dental  Surgeon  of  United  States  Army  and  Pres- 
ident of  Army    'Examining  Board  for  Dental 
Surgeons, 

Octavo.      635    pages.       725    illustrations. 

Cloth,  $5.00.     Sheep,  $6.00. 

J.B.LIPPINCOTT  COMPANY 

PUBLISHERS  PHILADELPHIA 


Mouth  Hygiene 

AND 

Mouth  Sepsis 


BY 

JOHN  SAYRE    MARSHALL,  M.D.,  Sc.D. 

SYRACUSE   UNIVEB8ITT 

CAPTAIN  U.  S.  ARMY  RETIRED 

FELLOW   AMERICAN   COLLEGE    SURGEONS;    FORMERLY    EZAMIinNQ    AND 
BUPEBVI8ING   DENTAL  SURGEON   U.  8.   ARMY;   PRESIDENT 
OF  THE   BOARD   OF   EXAMINERS. 

SECOND  EDITION,  REVISED 


PfflLADELPHIA  &  LONDON 
J.  B.  LIPPINCOTT  COMPANY 


Copyright,  1912 
Bt  J.  B.  LippiNcoTT  Company 

COPTRIGHT,   1916 

By  J.  B.  LippiNcoTT  Company 


K  K  30  5 


Printed  by  J,  B,  Lippincott  Company 
The  Washington  Square  Press,  Philadelphia,  U,  S,  A. 


To 

MY  DEAR  WIFE 

Who  For  More  Than  Forty  Years   Has   Been  My 

Chief   Inspiration  This  Little  Book  Is 

Affectionately  Dedicated. 


or. 


in 


PREFACE  TO  SECOND 
EDITION 

It  is  with  great  pleasure  that  the  writer 
has  prepared  the  Second  Edition  of  this 
little  text-book.  This  pleasure  has  been 
enlianced  by  the  fact  that  it  has  seemed, 
as  was  the  hope,  to  meet  the  demand  for 
information,  and  stimulated  the  ever- 
growing interest  of  the  dental  and  medical 
professions,  as  well  as  the  general  public, 
in  the  subjects  of  mouth  hygiene  and 
mouth  sepsis. 

The  interest  which  has  been  awakened 
all  over  the  civilized  world  to  the  supreme 
importance  of  maintaining  a  healthful  con- 
dition of  the  teeth  and  the  mouth,  and  the 
great  danger  to  individual  health  and  life 
which  lurks  in  a  septic  mouth,  has  already 
done  much  towards  mitigating  these  evils 
by  stimulating  the  people  to  give  greater 
attention  to  oral  hygiene. 

vi 


PREFACE  TO  SECOND  EDITION 

The  book  has  been  carefully  revised  and 
several  new  illustrations  have  been  added. 

It  is  the  hope  of  the  writer  that  those 
who  read  its  pages  may  be  inspired  to  arise 
to  the  relief  of  the  poor,  the  indigent,  and 
the  unfortunate  in  their  midst,  who  are  in 
such  vital  need  of  appropriate  dental 
treatment  to  safeguard  their  health  and 
perhaps  save  their  lives,  by  encouraging 
the  establishment  of  free  dental  clinics  in 
every  community. 

The  writer  and  his  publishers  desire  to 
acknowledge  their  obligations  to  the  pro- 
fession and  the  reading  public  for  their 
generous  patronage  and  trust  that  the  re- 
vised and  enlarged  work  will  meet  with 
the  same  generous  support. 

The  Author. 

2912  Pine  Ave.,  Berkeley, 
January,  1916. 


PREFACE 

In  the  preparation  of  this  little  text- 
book the  writer  has  endeavored  to  meet 
the  needs  of  the  Dental  Profession,  of 
students  of  dentistry  and  medicine,  trained 
nurses,  school-teachers,  sanitarians,  and 
the  general  public,  for  a  work  on  the  sub- 
ject of  mouth  hygiene  and  mouth  sepsis 
that  would  be  comprehensive  and  not 
too  technical. 

All  technical  terms  when  used  have 
been  explained,  so  that  the  lay  reader 
will  be  able  to  grasp  the  subject  with  the 
same  degree  of  understanding  as  would 
the  student  of  dentistry  or  medicine. 

The  subject  is  one  of  such  vast  impor- 
tance to  individual  and  public  health,  in- 
tellectual progress,  and  good  citizenship, 
that  it  is  hoped  that  the  facts  here  gath- 
ered, and  the  suggestions  made,  will  not 
only  prove  instructive  and  interesting  as 


VUl 


PREFACE 

matters  of  reference,  but  may  be  instru- 
mental in  creating  greater  interest  and  en- 
thusiasm in  the  subject  of  mouth  hygiene, 
and  thus  save  many  children  from  lives 
of  misery  caused  by  preventable  oral  dis- 
eases, which,  if  uncorrected,  may  lead  to 
invalidism,  immorality,  drunkenness, 
crime,  or  insanity. 


CONTENTS 


PART  I. 
MOUTH  HYGIENE 

CHAPTER  PAGE 

I.    Introduction 1 

II.    Prevalence  of  Oral  Diseases 19 

III.    The  Human  Mouth  ;  Its  Care  From  Birth 

TO   THE   Completion  of  First  Dentition        S4 
IV.    The    Human    Mouth  ;    Its    Care    During 

Second  Dentition 53 

V.    The    Human    Mouth;    Its    Care    Durestq 

Illness 78 

VI.  Proper  Mastication  and  Proper  Breath- 
ing          91 

VII.    Oral  Hygiene,  and   the    School    Curric- 
ulum           99 

PART  II. 

VIII.    Mouth  Sepsis 109 

IX.    Diseases  of  the  Teeth  and  Mouth  Caused 

BY  Oral  Sepsis 128 

X.     Diseases    of    the    Throat,   the  Ear,   the 
Eye,  and  the  Cervical  Glands  Caused 

BY  Oral  Sepsis 141 

XI.  Diseases  of  the  Stomach,  Intestines, 
and  Other  Viscera  Caused  by  Oral 
Sepsis 164 


CONTENTS 

XII.  The    Psychological   Effects    of    Dental 

AND  Oral  Diseases  and  Sepsis 183 

XIII.  The  Psychological   Effects  of    Physical 

Deformities 194 

XIV.  Oral  Sepsis  and  Reflex  Dental  Irrita- 

tion AS  Causes  of  Drunkenness,  Neuras- 
thenia, Melancholia,  and  Insanity  ....       204 

PART  III. 

XV.    The  National  Oral  Hygiene  Propaganda 

and  the  Result  of  Experimental  Work      225 


ILLUSTRATIONS 

FIG.  PAGE 

I.    Head  of  Infant,  Front  View,  showing  Pri- 
mary Dentition  at  about  the  Seventh 

Month 40 

II.     Right  Side  of  Same 40 

III.  Left  Side  of  Same 40 

IV.  Head  of  Child,  Front  View,  showing  Com- 

plete Primary  Dentition  and  Secondary 
Dentition  in  Various  Stages  of  Forma- 
tion         54 

V.    Right  Side  of  Same 54 

VI.     Left  Side  of  Same 54 

VII.     Adult  Head,  showing  Complete  Secondary 

Dentition.     (After  Dr.  Cryer) 58 

VIII.    Calcification  of  Deciduous  and  Perma- 
nent Teeth 58 

IX.    Showing  Unclean  Mouth  and  Teeth.  ...       68 
X.     Showing  Same  after  the  Teeth  had  been 

Cleaned  and  Polished 68 

XI.    Watkins'  Adult  and   Child's  Tooth- 
brushes         72 

XII.     Prophylactic  Tooth-brush 72 

XIII.  FixDss  Silk  Holder  (for  Toilet  Table)  .  .       72 

XIV.  Floss   Silk   Holder  (fcr  Vest-pockj:t  or 

Chatelaine) 72 

XV.    Tongue  Scraper 74 

XVI.     Pyogenic  Bacteria 110 

XVII.    Mouth  Bacteria 110 

XVIII.     Infected  Dentine,   showing   Dental  Tu- 
buli  Greatly  Enlarged  and  Filled  with 

Micro-organisms 134 

xii 


ILLUSTRATIONS 

no.  PAQD 

XIX.  Infected  Dentine,  showinq  Coalescence 
OF  Enlarged  Dental  Tubuli,  forming 
Cavities,  and  filled  with  Micro-or- 
ganisms       134 

XX.    Showing  Impacted  Supernumerary  Lower 
Molar.    Dried  Specimen.     (After  Dr. 

Cryer) 206 

XXI.    Showing    Impacted    Cuspid,    Upper    Jaw. 

Dried  Specimen.     (After  Dr.  Cryer).  .     206 
XXII.    Showing  Inverted   Upper  Third  Molar, 

Living  Subject.     (After  Db.  Cbyeb)  . . .     206 


PART  I. 

MOUTH   HYGIENE 


MOUTH  HYGIENE  AND 
MOUTH   SEPSIS 

CHAPTER  I. 

INTRODUCTION. 

Hygiene. — Hygiene  is  that  branch  of 
sanitary  science  which  treats  of  the  laws 
of  health  and  its  preservation. 

Oral  Hygiene. — Mouth  hygiene  treats 
of  the  health  of  the  mouth  and  its 
preservation. 

Sanitary  Science. — The  science  which 
includes  a  consideration  of  all  that  can  be 
done  for  the  prevention  of  disease  and  the 
promotion  of  public  health. 

Sanitation,  therefore,  is  prophylaxis,  and 
prophylaxis  is  the  prevention  of  disease. 

Health. — That  condition  of  the  body 
in  which  all  its  organs  are  performing 
their  functions  in  a  normal  manner.  A 
hale  or  whole  condition  of  body. 

A  noted  monarch  once  said,  "  The 
health  of  the  people  is  the  supreme  law." 
A  sentence  more  wise  than  this  was  never 


MOUTH  HYGIENE 

spoken  by  human  lips,  for  the  idea  here 
expressed  lies  at  the  very  foundation  of 
all  material,  intellectual  and  spiritual 
progress  of  a  nation;  and  without  it  no 
true  national  greatness  can  ever  be 
attained. 

This  fact  is  becoming  more  and  more 
generally  recognized  by  all  civilized  na- 
tions, and  much  interest  is  being  mani- 
fested by  the  public  generally  in  the 
efforts  that  are  being  made  to  stamp  out 
disease,  improve  the  public  health,  and 
increase  longevity. 

With  this  end  in  view  great  efforts 
are  being  made  by  the  national  govern- 
ment, by  the  various  State  governments 
and  municipal  boards  of  health  along 
the  lines  of  scientific  sanitation  to  pro- 
tect the  public  and  the  individual  from 
the  detrimental  effects  of  impure  water, 
unwholesome  foods  and  beverages;  the 
poisonous  emanations  of  decomposing 
garbage  and  sewerage;  the  harmful  ef- 
fects of  bad  and  insufficient  ventilation, 
and  the  overcrowding  of  tenement  houses ; 
the  isolation  of  all  persons  afflicted  with 
infectious  and  contagious  diseases,  and 
the    fumigation    of    clothing    worn    and 

2 


INTRODUCTION 

buildings  occupied  by  such  persons;  the 
fumigation  of  all  vessels  upon  which  such 
diseases  are  found  and  the  cargoes  therein 
contained. 

Physicians  generally  are  teaching  their 
patients  the  value  of  observing  the  various 
common  rules  of  hygiene  and  sanitation 
and  personal  cleanliness;  and  yet  the 
majority,  the  great  majority  have  not 
yet  learned  to  appreciate  the  fact  that 
an  unclean  mouth  is  a  most  prolific,  if 
not  the  most  prolific,  source  of  danger 
to  the  health  of  the  individual  of  which  we 
have  any  knowledge. 

Dr.  Osier,  in  a  recent  address  before 
the  students  of  the  Royal  Dental  Hospital 
of  London,  said,  "  You  have  just  one 
gospel  to  preach,  and  you  have  got  to 
preach  it  early,  and  you  have  got  to  preach 
it  late,  in  season  and  out  of  season.  It 
is  the  gospel  of  the  cleanliness  of  the 
mouth;  cleanliness  of  the  teeth;  cleanli- 
ness of  the  throat.  These  three  things 
must  be  your  text  through  life." 

"  Oral  hygiene — the  hygiene  of  the 
mouth — there  is  not  one  single  thing  more 
important  to  the  public  in  the  whole  range 
of  hygiene ;  and  it  is  with  that  which  you, 
as  practitioners,  will  have  to  deal." 


MOUTH  HYGIENE 

The  dentist  is  often  thought  to  ex- 
aggerate the  importance  of  a  clean, 
healthful  mouth  and  good,  serviceable 
teeth;  and  to  draw  upon  his  imagination 
when  he  speaks  of  the  dangers  to  the 
general  health  which  lie  hidden  in  decayed 
teeth,  dento-alveolar  abscesses,  pyorrhoea 
alveolaris,  and  other  dental  diseases. 

Upon  this  point  Prof.  Osier  has  also 
placed  himself  on  record.  He  says,  "  If 
I  were  called  upon  to  state  which  of  the 
two,  in  my  opinion,  causes  the  most  evil, 
alcohol  or  decayed  teeth,  I  should  un- 
hesitatingly say  decayed  teeth." 

Dr.  Wiley,  pure  food  expert,  recently 
said,  "  One  thousand  children  die  daily  in 
this  country,  their  deaths  due  more  to  de- 
fective teeth  than  to  other  trouble." 

Dr.  Kirk,  of  the  Dental  Cosmos^  says: 
"  In  Great  Britain  a  systematic  study 
of  the  mouth  conditions  of  the  public- 
school  children  revealed  the  alarming  fact 
that  only  three  or  four  per  cent,  had 
sound  dentures,  and  that  dental  caries  was 
an  evil  that  was  undermining  the  health 
of  the  nation.  Similar  studies  in  other 
countries  furnished  statistics  which  in 
general  correspond  with  the  figures  ob- 
tained in  England,  showing  that  dental 


INTRODUCTION 

caries  is  a  disease  universal  in  its  distribu- 
tion and  constituting  a  factor  of  ill  health 
second  in  importance  to  no  other  which 
affects  the  human  race." 

Dr.  D.  D.  Smith,  in  a  paper,  read 
before  the  New  York  Institute  of 
Stomatology,  upon  Oral  Prophylaxis/ 
says:  "  It  may  seem  presumptuous  to  in- 
timate that  in  this  subject  of  oral  prophy- 
laxis, when  fully  comprehended,  are 
matters  of  a  magnitude  to  radically 
modify  the  present  thought  and  concep- 
tion of  dentistry,  and  to  greatly  change 
the  present  methods  of  practice.  To  ad- 
vance a  step  farther,  and  suggest  that 
there  are  hidden  away  under  the  debris 
of  the  oral  cavity  secrets  of  greater  im- 
portance to  the  comfort  and  welfare  of 
civilization  than  the  great  discovery  of 
vaccination  by  Jenner  in  1796,  will  doubt- 
less seem  as  a  magnification  verging  upon 
absurdity.  And  yet  we  venture  to  pre- 
dict that  the  future  of  dentistry  will 
disclose  this  as  a  truism." 

Dr.  L.  Ashley  Faught, "  in  speaking 


^International  Dental  Journal,  vol.  xxli,  p.  817,  1901. 
2 Dental  Cosmos,  vol.  xliv,  p.  1021,  1902. 

5 


MOUTH  HYGIENE 

of  Oral  Hygiene,  says:  "  It  has  come  to 
be  more  appreciated  that  one  of  the  great 
causes  of  decay  in  the  teeth  is  lack  of 
cleanliness,  and  that  decay  begins  at  the 
outer  surface  of  the  tooth,  most  frequently 
at  the  points  most  difficult  to  keep 
clean.  .  .  .  Clearly  the  work  of  the 
patient  is  oral  hygiene, — the  maintaining 
of  the  oral  cavity  in  a  state  of  health. 
The  work  of  the  dentist  is  dental  prophy- 
laxis,— the  placing  of  the  teeth  in  condi- 
tion to  prevent  disease,  a  state  favorable 
to  oral  hygiene.  Thus  it  appears,  from 
any  strict  definition  of  the  two  words, 
that  the  end  to  be  obtained  by  either 
dentist  or  patient  is  one  and  the  same, 
— prevention  of  disease,  maintenance  of 
health." 

In  an  article  on  Oral  Hygiene  read  by 
Dr.  L.  P.  Bethel,  ^  he  quotes  Dr.  Knowl- 
ton,  dental  examiner  at  the  Barberton, 
Ohio,  Diamond-match  Factory,  as  say- 
ing: "  He  is  confident  that  the  influence 
of  oral  hygiene  is  farther  reaching  than 
ordinarily  imagined.  Since  its  enforce- 
ment among  these  employees  it  has  been 


"Fourth  International  Dental  Congress,  St.  Louis,  1904. 

6 


INTRODUCTION 

a  noticeable  fact  that  fewer  days  are  lost 
through  sickness.  He  believes  it  has  an 
influence  on  the  digestive  tract  and  that 
better  general  health  is  maintained.  Also 
it  has  been  noticed  that  during  epi- 
demics of  disease  fewer  employees  are 
affected  by  prevailing  maladies  than  be- 
fore these  prophylactic  measures  were 
adopted." 

THE  UNCLEAN  MOUTH. 

We  know  of  nothing  that  is  more 
shocking  and  disgusting  than  a  moutli 
which  is  a  stranger  to  the  tooth-brush, 
or  one  that  only  semi-occasionally  is 
treated  to  a  half-hearted  scrubbing  with 
this  most  invaluable  toilet  article.  Do 
we  not  turn  away  from  such  individuals 
with  positive  loathing?  Do  we  not  shun 
them  almost  as  much  as  we  would  an 
individual  suffering  from  small-pox? 
And  why?  Because  they  are  poisoning 
the  air  which  you  and  I  must  breathe 
with  myriads  of  disease-producing  micro- 
organisms, perhaps  the  organisms  of  pul- 
monary tuberculosis,  pneumonia,  diph- 
theria, tonsillitis,  bronchitis,  la  grippe, 
and  numerous  others. 


MOUTH  HYGIENE 

The  science  of  bacteriology  applied  to 
the  study  of  the  organisms  found  in  the 
human  mouth  has  demonstrated  more 
than  a  hundred  different  forms,  many  of 
them  ^disease-producing  organisms.  In, 
fact  nearly  every  form  of  pathogenic 
micro-organisms  known  to  bacteriologic 
science  has  been  found  at  some  time  to  in- 
habit the  human  mouth.  This  being  the 
fact,  what  an  ever-present  danger  to  the 
individual  and  the  public  is  an  unclean, 
unsanitary,  unhygienic  mouth! 

In  this  connection  it  may  be  well  to, 
consider  for  a  few  moments  the  rapidity 
with  which  some  of  the  disease-producing 
micro-organisms  reproduce  themselves. 

MULTIPLICATION    OF    BACTERIA.* 

The  process  of  reproduction  in  bacteria 
is  a  very  rapid  one.  Fliigge  observed  the 
process  of  segmentation  in  a  coccus — 
a  globular  organism — to  be  completed  in 
twenty  minutes.  Cohn  has  made  the  cal- 
culation that  if  it  should  take  one  hour 
to   complete   this    process    of   segmenta- 


*  Marshall's    Operative    Dentistry,    third    edition,    pp. 
91,  92. 

8 


INTRODUCTION 

tion — di\asion — and  of  the  new  cell  to 
attain  the  size  of  the  parent  cell,  one 
coccus,  multiplying  by  this  process,  would 
in  a  single  day  produce  16,000,000 
progeny;  at  the  end  of  two  days  281,000, 
000,000 ;  while  at  the  end  of  the  third  day 
it  would  have  reached  the  enormous  num- 
ber 46,000,000,000,000.  Such  figures  are 
at  first  thought  very  startling,  and  if  the 
multiplication  could  go  on  unhindered  the 
earth  might  soon  be  dominated  by  these 
micro-organisms.  There  are,  however, 
many  curcumstances  which  constantly 
oppose  them;  one  of  the  chief  of  these  is 
their  own  delicate  susceptibility  to  change 
of  environment,  the  slightest  difference  in 
soil,  amount  of  oxygen,  temperature,  or 
moisture  being  sufficient  in  many  in- 
stances to  arrest  their  growth  or  com- 
pletely destroy  them.  Various  specimens 
are  found  growing  together,  but  the 
struggle  for  existence,  and  natural  selec- 
tion, is  as  active  here  as  elsewhere;  the 
stronger  and  more  vigorous  soon  destroy 
the  weaker.  When  they  enter  healthy 
bodies  they  are  attacked  by  the  phago- 
cytes— the  white  cells  of  the  blood — and 
destroyed,  or  they  do  not  find  a  congenial 


MOUTH  HYGIENE 

soil  in  which  to  grow,  and  either  die  or 
are  swept  out  of  the  body  by  the  ex- 
cretory organs. 

Miller  ^  has  made  the  estimate  that  in 
a  certain  very  unclean  mouth  there  were 
not  less  than  1,140,000,000  micro-organ- 
isms. iThink  of  the  vitiating  effect  of 
such  a  mouth  upon  the  general  health 
of  the  individual  and  upon  the  atmosphere 
of  a  room  inhabited  by  such  a  person;  of 
the  myriads  of  these  organisms  that  en- 
ter the  lungs  at  every  inspiration  and  of 
the  myriads  that  are  thrown  into  the 
atmosphere  by  every  expiration  and  by 
every  act  of  coughing  or  sneezing;  of  the 
multitudes  that  are  swallowed  with  every 
mouthful  of  food  or  drink ;  of  their  effect 
upon  the  delicate  lining  membrane  of  the 
bronchi  and  air-vescicles  of  the  lungs,  and 
upon  the  mucous  membrane  of  the 
stomach  and  intestines.  The  wonder  is 
that  diseases  of  the  throat,  of  the  air- 
passages,  of  the  lungs,  and  of  the  stomach 
and  intestinal  tract  are  not  more  common 
than  they  are. 

The  unclean  mouth  is   always  a  dis- 


*  Micro-organisms  of  the  Human  Mouth. 

10 


INTRODUCTION 

eased  mouth.  It  has  been  said,  "  The 
man  with  the  healthy  mouth  is  never  sick : 
the  sick  man  never  has  a  healthy  mouth." 
The  first  part  of  this  proposition  may  be 
open  to  question,  but  the  latter  never.  A 
man  with  a  healthy  mouth  may  eat  food 
or  drink  water  or  milk  infected  with  the 
cholera  bacillus  or  the  typhoid  bacillus, 
and  die  from  their  effects,  in  the  former 
case  in  a  few  hours,  in  the  latter  in  a  few 
days  or  two  or  three  weeks. 

As  a  general  proposition,  however,  the 
statement  is  correct,  for  the  man  with 
the  healthy  mouth  is  usually  in  vigorous 
health  and  will  be  able  to  resist  these  in- 
fections if  the  organisms  are  not  intro- 
duced in  overwhelming  numbers.  If  his 
opsonic  index  is  high,  which  is  another 
way  of  saying,  if  his  resistance  power  is 
high,  he  may  escape  altogether.  The  man, 
however,  who  has  an  unclean  and  diseased 
mouth  has  never  a  high  resistance  power 
against  disease.  "  Cleanliness  is  next  to 
godliness,"  and  godliness  is  to  be  Godlike. 
Can  any  one  conceive  of  our  God  being 
unclean?  Therefore,  if  we  are  Godlike 
we  must  be  clean  physically,  morally,  and 
spiritually.     If  we  are  Godlike  we  will 

11 


MOUTH  HYGIENE 

be  every  whit  clean  physically  as  well  as 
in  other  respects,  and  if  we  are  every 
whit  clean  we  will  have  clean  mouths  and 
keep  them  so. 

The  tooth-brush  Is  the  yard-stick  by 
which  the  degree  of  civilization  of  a  people 
or  a  nation  may  be  measured.  From  time 
immemorial  the  care  which  a  people  or  a 
nation  has  given  to  its  teeth,  is  the  index 
of  the  degree  of  its  civilization. 

Booker  Washington,  of  Tuskegee,  has 
said,  "  The  tooth-brush  is  the  greatest  of 
all  civilizing  agents."  He  found  that 
when  he  had  succeeded  in  teaching  his 
students  to  keep  their  teeth  clean,  he  had 
stimulated  in  them  a  sense  of  self-respect, 
and  this  is  necessary  to  civilization  in  its 
higher  forms. 

This  is  to  be  the  age  of  the  tooth-brush, 
and  the  gospel  of  the  tooth-brush  is  to 
be  preached  from  one  end  of  the  world 
to  the  other,  and  nothing  shall  stop  it, 
for  it  is  a  righteous  gospel  and  one  that 
has  for  its  aim  the  betterment  of  the 
health  and  consequently  of  the  happiness 
of  the  human  race. 

Hygiene  of  the  mouth  must  deal,  not 
only  with  the  question  of  cleanliness,  but 

12 


INTRODUCTION 

also  with  disease^!  conditions  and  their 
prevention.  An  unclean  mouth  leads  to 
decay  of  the  teeth,  and  decay  of  the  teeth 
leads  to  exposure  of  pulps — miscalled 
nerves — which  causes  most  excruciating 
pain.  This  condition  if  neglected  leads 
to  dento-alveolar  abscess — miscalled  ul- 
cerated teeth — which  not  only  causes 
severe  pain  and  great  swelling  when  the 
abscess  is  an  acute  one,  but  it  may  lead 
to  acute  septicaemia — blood-poisoning — 
and  not  infrequently  to  death.  Or  if  the 
abscess  pass  into  the  chronic  stage  it  may 
give  rise  to  pyaemia — a  chronic  state  of 
blood-poisoning — which  may  continue  for 
months  and  finally  end  in  death  unless 
the  cause  is  discovered  and  removed. 
Another  diseased  condition  frequently 
found  in  the  unclean  mouth  is  gingivitis — 
inflammation  of  the  gums — usually  caused 
by  the  accumulation  of  salivary  calculus — 
tartar — and  the  accumulations  of  food 
debris — particles  of  food  left  upon  and 
between  the  teeth,  which  are  soon  in  a 
state  of  acid  fermentation  from  the  action 
of  certain  bacteria  always  found  in  the 
human  mouth,  and  which  in  a  few  hours 
forms  acids  which  dissolve  the  lime  salts 

13 


MOUTH  HYGIENE 

in  the  enamel  and  dentine  and  thus  estab- 
lish dental  decay;  while  the  accumula- 
tion of  the  tartar  and  the  food  debris  act 
as  mechanical  and  chemical  irritants  to  the 
gum  tissue  and  thus  establish  inflamma- 
tion of  the  gums. 

This  condition  of  inflammation  of  the 
gums  frequently  leads  to  atrophy — a 
wasting  away  of  tissue — and  to  a  loss  of 
the  alveolus — bony  socket  of  the  tooth — 
by  a  process  of  caries — an  inflammatory 
condition  which  dissolves  the  bone  by  slow 
degrees —  and  ends  in  the  final  loss  of  the 
tooth. 

Another  disease  that  is  frequently 
found  in  an  unclean  mouth  is  pyorrhoea 
alveolaris,  or  Riggs's  disease — a  chronic 
inflammation  located  in  the  pericemen- 
tum— membrane  covering  the  roots  of  the 
teeth — and  in  the  alveolar  process  or  sock- 
ets of  the  teeth,  which  produces  a  gradual 
and  painful  dissolution  of  these  structures 
accompanied  by  a  flow  of  pus  from  fhe 
alveolus  or  socket,  resulting  in  an  ulti- 
mate loss  of  the  teeth,  and  due  to  con- 
stitutional causes,  such  as  rheumatism, 
gout,  diabetes,  and  Bright's  disease,  and 
aggravated     by     local     irritation     from 

14 


INTRODUCTION 

salivary  deposits — tartar — and  the  accu- 
mulation upon  and  around  the  teeth  of 
food  debris  which  is  in  a  septic  or  putrefy- 
ing condition. 

Stomatitis — inflammation  of  the  lining 
mucous  membrane  of  the  mouth — in  its 
various  forms  is  frequently  present  in  an 
unclean  mouth.  This  disease  is  most  often 
found  in  the  mouths  of  infants  and  little 
children,  particularly  in  foundling  hospi- 
tals and  orphan  asylums.  It  is  an  infec- 
tious disease  and  readily  transmitted  by 
nursing-bottles,  spoons,  and  drinking- 
cups.  The  disease  is  mj^cotic — fungus 
micro-organisms — in  its  origin ;  the  organ- 
isms flourishing  in  unclean  rubber  nipples, 
nursing-bottles,  rubber  soothers  or  com- 
forts, milk-bottles,  and  unsanitary  re- 
frigerators, etc. 

Pharyngitis — inflammation  of  the  back 
part  of  the  throat — is  another  common 
disease  often  found  associated  with  an 
unclean  mouth,  and  is  due  usually  to  in- 
fection from  the  mouth. 

Tonsillitis — inflammation  of  the  glands 
lying  upon  either  side  of  the  inner  surface 
of  the  throat — is  usually  found  associated 
with  an  unclean  mouth.     It  is  an  infec- 

15 


MOUTH  HYGIENE 

tious  disease,  and  is  also  due  to  micro- 
organisms. This  disease  spreads  very 
rapidly  among  school-children  housed  in 
close  and  ill-ventilated  school-rooms  and 
who  are  permitted  to  use  common  drink- 
ing-cups,  common  towels,  common  slates, 
pencils,  and  pens.  The  public  drinking- 
cup,  public  towels,  common  slates,  pencils, 
and  pens  should  be  banished  forever  from 
our  public  schools  as  an  imperative  sani- 
taiy  measm-e  against  the  spread  of  such 
infectious  and  contagious  diseases. 

One  of  the  precepts  taught  Japanese 
childi'en  in  their  schools,  and  has  been  for 
generations,  is  the  following:  "  Disease,  it 
is  said,  enters  through  the  mouth.  Be 
watchful  as  to  what  you  eat  and  drink." 
This  ought  to  be  written  in  letters  of  gold 
and  hung  on  the  walls  of  all  school-rooms. 

During  the  hot  season  of  the  year  city 
people  who  can  afford  to  do  so  flee  to  the 
country  with  their  children,  to  find  cool, 
pure  air  and  fresh  food,  and  this  is  wise 
and  beneficial,  provided  the  sanitary  con- 
ditions of  the  new  environment  are  what 
they  should  be.  Many  of  these  summer 
resorts   are   far   from   being   what  they 

16 


INTRODUCTION 

should  be,  from  a  sanitary  stand-point. 
The  ignorance  or  the  cupidity  of  the 
management  of  many  of  these  places  is 
such  that  they  make  no  adequate  pro- 
vision for  the  protection  of  the  water 
supply  from  contamination  with  the 
sewerage  of  the  premises,  and,  instead  of 
burning  all  kitchen  refuse,  cart  it  into 
some  back  lot  and  allow  it  to  rot  and 
putrefy  in  the  sun  and  breed  flies  by  the 
million.  Such  places  are  more  dangerous 
to  the  health  and  lives  of  the  children 
than  the  heat  and  possible  unsanitary  con- 
ditions from  which  they  have  fled. 

Flies  are  a  prolific  source  of  infection. 
They  are  the  most  filthy  of  all  insects, 
and  every  efl'ort  should  be  made  to  pre- 
vent their  propagation  and  multiplication 
by  destroying  all  matter  upon  which  they 
feed.  Refuse  from  the  kitchen,  garbage, 
excreta  of  the  body,  stable  droppings,  and 
refuse  should  be  removed  each  day  and 
destroyed  by  burning.  All  food  and 
nursery  apparatus  should  be  protected 
from  flies  by  proper  cover-screens.  Most 
of  the  sporadic  cases  of  typhoid  fever 
found  in  our  cities  can  usually  be  traced 
to  an  infection  received  at  some  supposed 
health  resort  or  summer  camp. 

«  17 


MOUTH  HYGIENE 

Most  people  are  extremely  careful  to 
have  the  foods  and  drink  which  enter  their 
mouths  free  from  everything  that  could 
be  considered  in  any  way  unsanitary ;  and 
yet  many  of  these  same  people  have  very 
unclean  mouths,  not  seeming  to  recognize 
the  fact  that  they  carry  within  their 
mouths  unsanitary  conditions  that  are 
infinitely  more  dangerous  to  health  and 
life  than  the  dirt  and  possibly  infectious 
materials  that  have  been  removed  in  the 
careful  preparation  of  their  food,  and 
which,  when  thoroughly  masticated  in  an 
unclean,  unsanitary  mouth,  has  been  ren- 
dered positively  unfit  to  enter  the  stomach. 
Is  this  failure  to  recognize  the  importance 
of  a  clean  mouth  due  to  ignorance,  in- 
difference, or  inconsistency?  We  think 
we  may  safely  say,  in  deference  to  the 
usual  habits  of  the  people  generally,  that 
it  is  due  to  ignorance  of  the  facts.  With 
this  thought  in  mind  it  will  be  our  en- 
deavor to  lay  these  facts,  as  best  we  may, 
before  our  readers  in  the  following  pages. 


CHAPTER  II. 

THE  PREVALENCE  OF   ORAL  DISEASES. 
ORAL  DISEASES. 

Diseases  of  the  mouth  are  so  prevalent 
that  it  may  be  said  practically  no  one 
escapes.  The  writer  during  a  practice, 
both  civil  and  military,  of  more  than  forty 
years,  in  which  he  has  examined  many 
thousands  of  mouths,  has  never  met  with 
but  four  instances  of  persons  who  had 
reached  adult  life  who  were  free  from 
any  form  of  dental  or  oral  disease.  One 
was  a  young  lady  twenty-four  years  of 
age,  another  a  gentleman  of  fifty,  the 
third  an  officer  in  the  United  States 
Army,  twenty-four  years  old,  a  recent 
graduate  of  West  Point,  and  the  fourth 
a  lady,  a  college  graduate,  twenty-five 
years  of  age. 

Dental  caries — dental  decay — is  with- 
out doubt  the  most  common  disease  that 
affects  the  human  family  at  the  present 
time,  and  from  which  very  few  persons 

19 


MOUTH  HYGIENE 

among  civilized  nations  wholly  escape.  It 
seems  to  be  pre-eminently  a  disease  of 
higher  civilization,  as  it  is  most  common 
among  those  nations  which  are  recognized 
as  having  the  highest  civilization ;  and  yet 
no  race  or  tribe  of  men  yet  discovered, 
whether  savage,  barbarous,  semi-civilized, 
or  civilized,  ancient  or  modern,  has  ever 
wholly  escaped  it.  Archaeology,  history, 
and  anthropology  all  prove  the  correctness 
of  this  statement.  Evidences  are  not  lack- 
ing that  the  prehistoric  man  suffered  from 
dental  decay,  alveolar  abscesses,  —  mis- 
called ulcerated  teeth — and  other  dental 
diseases.  Many  of  the  Egyptian  mum- 
mies found  in  our  great  museums,  and 
skulls  of  prehistoric  periods,  show  well- 
marked  evidences  of  caries  and  other  den- 
tal diseases.  One  Egyptian  mummy  in  the 
British  Museum,  dating  back  to  a  period 
about  2800  B.  C,  or  more  than  four 
thousand  seven  hundred  years  ago,  shows 
undisputed  evidences  of  dental  caries  and 
other  dental  lesions. 

The  collections  of  crania  of  the  pre- 
historic inhabitants  of  North  and  South 
America  in  the  National  Museum  in 
Washington  show  occasional  evidences  of 

20 


ORAL  DISEASES 

dental  caries  and  numerous  evidences  of 
alveolar  abscess,  from  death  of  the  tooth- 
pulp  caused  by  the  wearing  down  of  the 
teeth.  Evidences  of  pyorrhoea  alveolaris 
are  very  rare.  Dental  anomalies,  particu- 
larly irregularities  in  position,  inverted 
teeth,  and  supernumerary  teeth,  are  quite 
common. 

It  would  be  interesting  to  pursue  this 
subject  at  greater  length  did  space  in  this 
little  volume  permit. 

PREVALENCE   OF   DENTAL   DISEASES   AMONG 
SCHOOL   CHILDREN. 

Very  little  interest  has  been  manifested 
by  the  profession  in  the  gathering  of  re- 
liable statistics  upon  this  subject  until 
quite  recently.  The  first  comprehensive 
and  reliable  work  of  this  kind  was  per- 
formed by  the  School  Committee  of  the 
British  Dental  Association  (Tomes). 
They  reported  having  examined  the 
mouths  of  3368  boys  and  girls  at  the  Han- 
well  and  Sutton  schools  and  at  the  Ex- 
mouth  training-ship.  Out  of  this  number 
only  twenty- three  per  cent,  had  sound 
dentures,  or,  in  other  words,  seventy- 
seven  per  cent,  were  affected  with  dental 

21 


MOUTH  HYGIENE 

decay.  These  boys  and  girls  ranged  from 
three  and  a  half  to  seventeen  years  of  age, 
but  the  majority  were  from  five  to  four- 
teen. Two  hundred  and  five  children 
belonging  to  high-class  schools  did  not 
compare  favorably  with  those  less  fortu- 
nately placed.  Further  comparison  was 
not  made,  as  the  number  was  too  small 
to  give  conclusive  results. 

Major  P.  J.  Probyn,  of  the  medical 
service  of  the  British  Army,  says :  ^ 

"  On  comparing  the  various  recruiting 
returns  in  the  Army  Medical  Department 
reports,  we  find  that  an  immense  amount 
of  good  material  is  lost  to  the  service 
from  defective  teeth,  either  due  to  cario- 
necrosis — dental  decay — or  the  actual  loss 
of  the  members;  and  this,  be  it  noted, 
occurs  in  otherwise  strong  and  healthy 
youths,  who,  if  fitted  with  artificial  den- 
tures, may  still  become  useful  fighting 
men.  At  one  time  the  Government  would 
not  allow  the  enlistment  of  men  with  de- 
fective teeth,  and  not  without  a  certain 
good  reason,  for  what  use  is  a  man  in 
the  field  with  defective  teeth?     He  yiill 


^  British  Journal  of  Dental  Science,  vol.  li,  p.  873,  1908. 

22 


ORAL  DISEASES 

soon  lose  his  good  state  of  health  if  he  is 
not  able  to  thoroughly  masticate  the  hard 
biscuit  and  '  bully  '  beef.  Now  I  am  glad 
to  say  a  much  more  liberal  view  is  taken 
of  the  situation,  and  recruiting  officers 
are  not  hampered,  but  must  use  their  own 
discretion  and  may  admit  men  with 
artificial  dentures. 

*'  In  the  last  report  of  the  Army  Medi- 
cal Department  (1907)  we  find  that  19 
per  cent,  of  the  candidates  were  lost  to 
the  army  on  account  of  defective  teeth." 

Ottofy  computed,  from  an  examination 
of  14,644  teeth  of  American  public-school 
children,  that  dental  caries  was  present 
in  27.33  per  cent,  in  the  boys  and  32.67 
per  cent,  in  the  girls. 

This  statement  gives  a  better  showing 
for  the  American  public-school  children 
than  for  the  children  in  the  Hanwell  and 
Sutton  charity  schools.  This  difference 
is  explained  by  the  fact  that  the  latter 
children  were  from  the  poorest  class  of 
English  society,  while  the  American 
public  school  represents  all  classes  of 
society,  including  many  who  receive  regu- 
lar attention  from  the  family  dentist. 

The   Schleswig-Holstein  Dental   Soci- 

28 


MOUTH   HYGIENE 

ety,  ^  in  a  recent  examination  of  the 
mouths  of  the  school-children  in  Northern 
Germany,  conducted  by  Dr.  Greve  of 
Lubeck,  reports  that  of  19,725  children 
examined,  95  per  cent,  showed  dental 
caries.  This  investigation  included  the 
children  of  nineteen  towns.  The  boys 
were  found  to  have  somewhat  better  teeth 
than  the  girls,  the  difference  being  about 
3  per  cent,  in  favor  of  the  boys. 

From  the  dental  inspection  of  the  public 
schools  of  the  city  of  Antwerp  in  1900  "^ 
the  following  facts  were  obtained:  "  The 
number  of  attendants  of  the  schools  in 
March  were — boys  9543;  girls  10,148; 
kindergarten  4778;  total  24,469.  The 
kindergartens  are  frequented  by  children 
of  three  to  six  years  of  age;  in  the  other 
schools  the  ages  vary  between  six  and  six- 
teen years.  Amongst  12,000  children  ex- 
amined by  Dr.  Verhuysen,  he  found  1721 
without  caries,  2138  with  one  or  two  teeth 
affected,  and  8141  with  several  teeth 
affected.  During  the  first  inspection  947 
extractions  were  made,  in  the  second  545, 


'Cor.  Blatt  fur  Zahn.,  July,  1899. 

•  Transactions  American  Public  Health  Assn.,  vol.  xxvii, 
p.  287. 

24 


ORAL  DISEASES 

and  in  the  third  405,  making  a  total  of 
1897."  Associated  with  the  decay  of  the 
teeth  were  numerous  other  abnormal  con- 
ditions, such  as  inflammation  of  the  maxil- 
lary sinus,  facial  phlebitis,  necrosis,  noma, 
ranula,  and  epulis. 

"  The  statistics  lately  compiled  of 
children  of  six  to  fourteen  years  of  age 
and  youths  from  twenty  to  twenty-three 
years  of  age  in  Germany  by  the  recom- 
mendation of  Rose  are  no  less  lamentable. 
The  best  localities  showed  78  per  cent,  of 
the  people  with  diseased,  teeth,  and  in 
places  w^here  calcium  was  scarce  (?)  the 
percentage  reached  99."  ^  Statistics  from 
Sweden  and  Russia  show  similar  con- 
ditions. Cunningham  found  that  in 
10,517  pupils  of  the  age  of  twelve  in 
English  and  Scotch  schools  85.8  per 
cent,  had  dental  decay. 

In  more  recent  examinations  made  of 
the  school-children  in  various  cities 
scattered  all  over  the  United  States  from 
north  to  south,  from  east  to  west,  it  has 
been  found  that  dental  and  oral  diseases 

*E.  Jessen  (of  Strassburg),  Trans,  American  Pub. 
Health  Assn.,  1901. 

25 


MOUTH  HYGIENE 

afflict  from  75  to  96.5  per  cent,  of  all  the 
children  examined. 

It  will  be  observed  by  the  preceding 
brief  summary  of  the  prevalence  of  dental 
and  oral  diseases,  ^  that  the  nations  of 
the  present  day  which  suffer  most  from 
these  affections  are  the  Anglo-Saxons  of 
America  and  Great  Britain,  and  the  great 
European  nations.  The  growth  of 
modern  dental  science  and  the  perfection 
of  the  art  among  these  nations  has  been 
a  work  of  necessity,  and  one  which  from 
its  surgical  and  prosthetic  aspects  has  kept 
pace  in  its  development  with  the  demands 
made  upon  it. 

But  viewed  from  the  more  important 
aspect  of  prophylaxis,  it  has  not  yet 
attained  nor  kept  pace  with  the  ever- 
increasing  needs  in  this  direction. 

When  one  stops  to  consider  how  wide- 
spread and  universal  dental  and  oral 
diseases  have  become,  and  the  increasing 
number  of  teeth  that  are  destroyed  by 
disease  every  year,  we  are  appalled  by 
the  problem,  and  wonder  if  the  human 
race  is  not  destined  to  become  edentu- 
lous— toothless. 

•Marshall's  Operative  Dentistry,  third  edition,  p.  130. 

26 


ORAL  DISEASES 

The  teeth  of  the  present  generation 
seem  to  be  inferior  to  those  of  their  im- 
mediate ancestors,  while  the  children  of 
to-day  have,  as  a  rule,  a  greater  pre- 
disposition to  dental  diseases  than  their 
parents.  In  other  words,  there  seems  to 
be  a  gradual  deterioration  in  the  struct- 
ural development — perfection  of  develop- 
ment— of  the  teeth,  and  a  lowering  of 
the  resistive  powers  or  the  vital  energy 
of  the  system  against  the  encroachment 
of  disease. 

Perfection  in  the  structural  develop- 
ment of  the  teeth  of  city-bred  children 
of  the  middle  and  better  classes  of 
society  is  the  exception,  defective  teeth 
the  rule.  Little  children  between  the 
ages  of  three  and  six  years  are 
frequent  sufferers  from  dental  caries, 
odontalgia,  and  alveolar  abscess,  while 
very  many  have  defective  first  permanent 
molars  which  require  operative  treatment 
as  soon  as  they  are  erupted. 

<This  is  the  age  of  steam  and  electricity, 
of  the  lightning  exj)ress  train,  the  ocean 
greyhound,  of  the  electric  telegraph  and 
the  telephone,  the  high-speed  automobile 
and  the  flying-machine.    Men  and  women 

27 


MOUTH   HYGIENE 

too  have  seemingh^  partaken  of  the 
energy  and  speed  of  these  forces.  It  is 
an  age  of  rush  and  whirl.  Men  and 
women  vie  with  each  other  and  with  their 
sex  for  place  and  power.  In  business 
and  social  life,  in  educational  matters,  in 
pleasures  and  vices,  they  go  at  high- 
pressure  speed,  and  as  a  result  often 
break  down  at  a  period  of  life  when  under 
more  favorable  circumstances  they  would 
still  be  in  their  prime. 

These  conditions  are  manifested  every- 
where in  the  civilized  world,  but  most 
noticeably  in  the  great  cities,  where  the 
intensity  of  the  struggle  of  the  poor  for 
existence,  and  of  the  well-to-do  and  rich 
for  supremacy  over  their  fellows  in 
business,  social  pleasures,  education,  and 
display,  are  the  greatest.  Children  born 
under  such  circumstances  have  generally 
constitutions  which  are  far  from  robust, 
nor  equal  to  those  inherited  by  their 
parents,  and  as  a  consequence  they  are 
handicapped  in  their  struggle  for  exist- 
ence either  by  the  direct  inheritance  of 
disease,  or  of  tendencies  and  predisposi- 
tions to  disease  which  are  the  result  many 
times    of    the    terrible    deprivations    of 

28 


ORAL  DISEASES 

poverty,  of  overwork,  or  of  over-in- 
dulgence in  the  luxuries  and  the  pleasures 
of  life,  or  possibly  of  the  indiscretions  or 
the  vices  of  their  parents  or  earlier 
progenitors, — for  "  the  sins  of  the  fathers 
are  visited  upon  the  children,  unto  the 
third  and  fourth  generations" 

The  report  of  the  Surgeon-General  of 
the  U.  S.  Army  for  1903  shows  that  the 
percentage  of  dental  diseases  among  the 
troops  serving  in  the  United  States  was 
42.85.  For  those  serving  in  the  Philip- 
pine Islands  it  was  61.12,  or  18.27  per 
cent,  higher  than  for  troops  serving  in 
the  United  States,  while  for  those  who 
served  in  Cuba  and  Porto  Rico  it  was 
64.02,  or  21.17  per  cent,  higher  than  for 
those  who  served  in  the  United  States. 

During  the  years  1901,  1902,  1903  the 
dental  surgeons  of  the  United  States 
Army  treated  70,259  teeth  by  filling  or 
extraction.  Of  this  number  43,704  were 
in  the  upper  jaw  and  26,555  in  the  lower. 
The  percentage  of  caries  for  the  upper 
was  62.20,  while  in  the  lower  teeth  it  was 
37.80.  The  difference  in  liability  to 
caries  between  the  right  and  left  sides  is 
very  slight,  the  left  side  being  a  little 

29 


MOUTH   HYGIENE 

more  susceptible.  The  number  of  teeth 
treated  upon  the  right  side  was  35,000 
and  on  the  left  side  35,259,  the  percent- 
age for  the  right  side  being  49.81  and 
for  the  left  50.19,  a  difference  of  only 
0.38. 

In  1904  the  writer,  for  the  purpose  of 
obtaining  exact  data  as  to  the  condition 
of  the  teeth  of  the  United  States  soldiers 
under  the  most  favorable  conditions, 
selected  for  this  purpose  two  regiments 
that  had  recently  returned  from  the 
Philippine  Islands  after  the  service  of 
two  years  or  more.  These  examinations 
were  conducted  in  the  most  careful  and 
systematic  manner  by  the  writer  and  two 
junior  dental  surgeons  as  assistants,  with 
the  follo^^dng  results.  In  the  first  regi- 
ment it  was  found  that  89.17  per  cent, 
of  the  enlisted  men  were  in  need  of  im- 
mediate dental  treatment;  while  the  ex- 
amination of  the  second  regiment  revealed 
the  fact  that  97.25  per  cent,  of  this  com- 
mand were  in  a  like  condition.  Of  the 
number  in  both  regiments  who  did  not 
require  dental  treatment,  several  had 
been  fortunate  enough  to  receive  treat- 
ment by  the  army  dental  surgeons  just 

30 


ORAL  DISEASES 

before  sailing  for  the  United  States. 
The  condition  found  in  these  two  regi- 
ments, it  is  believed,  is  a  fair  sample  of 
the  conditions  to  be  found  in  all  United 
States  troops  who  have  served  in  the 
tropics  for  two  or  more  years. 

The  military  reports  of  the  armies  of 
Great  Britain  and  Europe  in  which  den- 
tal examinations  have  been  made  show  a 
similar  condition  in  relation  to  the  pre- 
valence of  dental  diseases.  Some  of  these 
nations  have  already  appointed  dental 
surgeons  to  care  for  the  teeth  of  their 
soldiers,  while  others  have  the  matter 
under  consideration.  The  German  Army 
has  taken  the  lead  in  the  matter  of  oral 
hygiene.  Orders  were  issued  some  time 
ago  that  every  soldier  should  brush  his 
teeth  at  least  once  each  day,  before 
morning  inspection,  and  it  was  made  the 
duty  of  the  first  sergeant  of  each  company 
to  see  to  it  that  this  order  was  strictly 
obeyed. 

In  the  Philippine  Division  of  the 
United  States  Army  the  authorities  have 
gone  a  step  farther,  by  the  issue  of  an 
order,  upon  the  recommendation  of  the 
writer   about    six    years    ago,    not   only 

81 


MOUTH  HYGIENE 

requiring  the  enlisted  men  to  brush  their 
teeth  every  day,  but  making  it  the  duty 
of  the  post  surgeon  at  the  monthly 
special  inspection  to  see  that  the  men 
were  keeping  their  teeth  clean,  and  to 
order  such  as  had  decayed  teeth  to  report 
to  the  dental  surgeon  for  treatment. 

Through  representations  made  to  the 
Surgeon-General  by  the  writer  in  1904, 
the  dental  requirement  for  enlistment  was 
raised  from  two  serviceable  opposing 
molars  in  each  jaw — one  above  and  one 
below — on  each  side,  to  four  serviceable 
opposing  molars  in  each  jaw — two  above 
and  two  below — on  each  side.  The  en- 
forcement of  this  requirement,  however, 
so  reduced  the  number  of  eligible  recruits 
that  the  War  Department  was  obliged 
to  return  to  the  original  requirement  of 
two  serviceable  opposing  molars  in  each 
jaw — one  above  and  one  below — classing 
the  bicuspids  as  molars.  The  experience 
of  the  writer  at  the  Columbus  Barracks 
Recruit  Depot  leads  him  to  the  opinion 
that  there  are  very  few  young  men  among 
the  class  who  apply  for  enlistment  that 
have  reached  the  age  of  twenty  years  who 
have  not  lost  the  first  permanent  molars, 

32 


ORAL  DISEASES 

or  in  which  these  teeth  are  not  badly  de- 
cayed; while  many  others  have  lost  from 
one  to  two  bicuspids. 

From  twenty-five  to  thirty  per  cent, 
of  all  the  recruits  passed  by  the  surgeons 
at  this  post  were  ordered  to  report  to 
the  dental  surgeons  as  needing  immediate 
treatment  for  dental  caries, — pulpitis, 
dento-alveolar  abscess,  salivary  calculus, 
gingivitis,   or  necrosed  teeth  and  roots. 

In  personal  conversations  with  volun- 
teer officers  who  served  in  Cuba  and  the 
Philippine  Islands  during  the  Spanish- 
American  War,  it  was  learned  that  from 
ten  to  twelve  per  cent,  of  the  enlisted 
force  of  their  several  commands  were 
constantly  incapacitated  for  duty  by 
reason  of  dental  diseases. 

The  introduction  of  dental  service  as 
a  part  of  the  medical  care  of  the  army 
has  greatly  reduced  this  percentage,  and 
bv  that  much  has  added  to  the  health, 
comfort,  and  efficiency  of  the  army. 

Great  Britain,  during  its  Boer  War, 
had  a  similar  experience,  and  was  obliged 
to  send  out  a  number  of  dental  surgeons 
to  combat  these  diseases. 


83 


CHAPTER  III. 

THE  HUMAN  MOUTH;  ITS  CARE  FROM 

BIRTH  TO  THE  COMPLETION  OF 

FIRST  DENTITION. 

The  Oral  Cavity,  or  mouth,  is  the 
entrance  to  the  alimentary  canal.  It  is 
a  grinding  and  mixing  organism,  —  to 
change  the  form  of  expression,  a  mill  in 
which  the  food  intended  for  the  nourish- 
ment of  our  bodies  is  ground,  triturated, 
and  mixed  with  the  fluids  from  the 
salivary  glands  and  prepared  to  be  acted 
upon  by  the  gastric  juices. 

This  cavity  is  formed  by  the  lips, 
cheeks,  tongue,  hard  and  soft  palate,  and 
the  jaws.  Emptying  into  this  cavity  by 
appropriate  ducts  are  three  series  of 
salivary  glands,  known  as  the  parotid, 
submaxillary,  and  sublingual.  These 
glands  secrete  fluids  which  contain  chemi- 
cal substances,  elaborated  by  the  vital 
processes  of  the  body,  ptyalin,  a  special 
ferment,  being  the  most  important,  as 
it  converts  starch  to  sugar  and  prepares 
it  to  be  acted  upon  by  the  secretions  of 
the  stomach. 

84 


THE  HUMAN  MOUTH 

Situated  in  the  surface  of  the  mucous 
membrane  of  the  lips,  cheeks,  palate,  and 
tongue  are  numerous  small  glands  for 
the  secretion  of  a  fluid  more  or  less  glairy 
in  consistence,  known  as  mucus.  At  the 
back  of  the  mouth  and  at  the  entrance 
of  the  throat  are  situated  two  almond- 
shaped  glands,  one  on  either  side,  known 
as  the  tonsils.  The  principal  known  func- 
tion of  these  glands  is  to  secrete  a  thick 
glairy  mucus,  which  envelops  each  bolus 
or  mouthful  of  food  when  ready  to  be 
swallowed,  and  thereby  assists  its  passage 
from  the  mouth  to  the  stomach. 

The  mouth  of  the  infant  when  first 
born  is  usually  devoid  of  teeth.  Cases 
are  on  record,  however,  in  considerable 
numbers  in  which  infants  were  born  with 
from  one  to  several  teeth.^  It  has  been 
stated  that  Richard  Coeur  de  Lion  of 
England  and  Louis  XIV  of  France  were 
born  each  with  several  teeth.  Haller,  in 
his  "  Elements  of  Physiology,"  mentions 
nineteen  cases  of  children  that  were  born 
with  one  or  more  teeth.  The  writer  has 
several  times  been  called  upon  to  remove 

*  Marshall's  Operative  Dentistry,  third  edition,  pp. 
61-66. 

S5 


MOUTH  HYGIENE 

teeth  from  the  mouth  of  the  new-bom  in- 
fant because  the  teeth  interfered  with 
nursing,  and  there  are  few  physicians  or 
dentists  of  twenty  to  twenty-five  years' 
practice  who  have  not  had  a  like  experi- 
ence. Dr.  Crump,  several  years  ago,  re- 
ported to  the  Virginia  Society  of  Dentists 
a  case  of  a  child  that  was  born  with  a 
full  set  of  deciduous  or  milk  teeth. 

The  normal  activity  of  the  salivary 
glands  does  not  become  established  until 
the  process  of  eruption  of  the  teeth — 
cutting  of  the  teeth — begins.  Up  to  this 
time  the  diet  of  the  infant  has  been  com- 
posed only  of  milk,  or  ought  so  to  be, 
and  there  has  been  no  occasion  for  the 
presence  of  saliva  containing  the  special 
ferment,  ptyalin.  Upon  the  appearance 
of  the  teeth  the  child  craves,  and  should 
have,  a  more  solid  diet,  which  its  alimen- 
tary system  is  gradually  being  prepared 
to  receive  and  digest.  No  more  repre- 
hensible practice  can  be  indulged  in  by 
young  mothers  and  nurses  than  that  of 
feeding  infants  with  materials  that  are  so 
manifestly  unfit  as  starchy  foods,  fruits 
and  meats  before  the  function  of  the  sali- 
vary glands  is  established  and  a  sufficient 
number  of  teeth  have  erupted  to  make 

S6 


THE  HUMAN   MOUTH 

mastication  possible.  More  children  die 
from  improper  feeding  than  from  all  other 
causes  combined. 

PRIMARY  DENTITION. 

The  eruption  or  cutting  of  the  decidu- 
ous or  milk  teeth  is  a  physiologic  process, 
and  in  a  normal  child  is  productive  of  so 
little  general  or  local  disturbance  that 
many  times  the  teeth  make  their  appear- 
ance within  the  mouth  before  the  parent 
or  the  nurse  has  realized  the  fact  that  the 
process  of  "teething"  has  really  begun; 
while,  upon  the  other  hand,  in  children 
mth  impaired  health  and  low  vitality  it 
often  plays  a  prominent  part  in  exciting 
various  morbid  conditions  of  the  digestive, 
nervous,  respiratory,  and  dermal  (skin) 
systems.  The  subject  becomes,  therefore, 
one  of  considerable  interest  to  the  medical 
attendant  and  the  dental  specialist  and  of 
serious  anxiety  to  the  parents. 

There  is  no  doubt  in  the  mind  of  the 
writer  that  the  dangers  from  dentition 
have  been  greatly  exaggerated  by  some 
authorities,  and  that  parents  are  often 
unnecessarily  anxious  for  their  offspring 
during  this  period;  yet  it  must  be  borne 
in  mind  that  in  certain  temperaments  and 

S7 


MOUTH  HYGIENE 

under  various  physical  conditions  and  en- 
vironment there  is  a  real  danger  present, 
and  that  morbid  phenomena  are  some- 
times excited  which  may  progress  to  a 
fatal  termination.  When  dentition  is  slow 
and  the  gums  swollen  and  painful,  lancing 
may  be  necessary,  but  this  should  be  de- 
termined by  the  physician  or  dental 
attendant. 

According  to  the  mortality  tables  of 
London,  as  cited  by  West,  dentition  was 
assigned  as  the  cause  of  death  of  4.8  per 
cent,  of  all  children  dying  under  one  year 
of  age,  and  7.3  per  cent,  of  those  who  died 
between  the  ages  of  one  and  three  years. 
This  is  not  a  high  mortality,  and  yet  it  is 
more  than  likely  that  a  goodly  number  of 
these  deaths  were  due  to  improper  feed- 
ing and  unclean  mouth  conditions,  rather 
than  dental  irritation. 

The  dangers  surrounding  the  period  of 
first  dentition  are  much  greater  in  large 
cities  and  in  overcrowded  localities,  par- 
ticularly among  the  middle  and  lower 
classes  of  society,  than  in  the  suburban 
and  country  districts.  But  the  greatest 
mortality  is  in  the  foundling  hospitals  and 
in  overcrowded  and  filthy  tenements.  A 
considerable  number  of  these  cases  are 

38 


THE  HUMAN  MOUTH 

without  doubt  due  to  the  unsanitary  and 
unhygienic  surroundings  of  these  children 
and  to  unfit  and  spoiled  food  upon  which 
they  have  been  fed. 

Contemporaneously  with  the  eruption 
of  the  teeth,  there  is  a  very  important 
developmental  process  taking  place  in  the 
follicular  or  glandular  apparatus  of  the 
whole  alimentary  canal,  in  preparation 
for  the  necessary  change  soon  to  take 
place  in  the  character  of  the  food  that  the 
system  will  demand. 

This  is  a  physiologic  process,  and  under 
normal  conditions,  when  all  the  functions 
of  the  body  are  nicely  balanced,  pro- 
gresses without  the  least  disturbance  of 
general  health;  but  under  opposite  con- 
ditions it  may  be  productive  of  serious 
gastric  and  intestinal  complications,  the 
causes  of  which — viz.,  an  unclean  mouth, 
improper  or  spoiled  food,  etc. — are  often 
overlooked,  and  the  disturbances  which 
are  the  result  of  these  indiscretions  during^ 
the  period  that  these  important  physio- 
logic changes  are  taking  place,  are 
attributed  to  morbid  dentition. 

The  nervous  system  of  the  child  at  this 
period  is  also  very  impressible,  the  cerebro- 
spinal apparatus  predominating  to  such 

39 


MOUTH   HYGIENE 

an  extent  that  slight  irritations  of  almost 
any  character,  in  children  of  certain  tem- 
peraments, may  be  followed  by  more  or 
less  general  systemic  disturbances,  with 
elevation  of  temperature,  vomiting,  diar- 
rhoea, bronchitis,  and  other  catarrhal  con- 
ditions, or  reflex  nervous  phenomena, 
like  strabismus, — squinting  or  cross-eye, — 
twitching  of  the  facial  muscles,  rolling 
of  the  eyes,  convulsions,  or  meningitis, — 
inflammation  of  the  brain. 

Normal  Primary  Dentition — cutting 
of  the  milk  teeth — begins  between  the 
fifth  and  eighth  months  after  birth,  and 
terminates  between  the  twenty- fourth  and 
thirty-second  months.  The  following 
table  represents  the  average  period  of  the 
eruption — cutting — of  the  various  classes 
of  teeth  which  constitute  the  temporary 
denture : 

The  central  incisors,  fron  5  to  8  months 

after  birth. 
The    lateral    incisors,    from    7    to    10 

months  after  birth. 
The  first  molars,  from  1'2  to  16  months 

after  birth. 
The  cuspids  (eye-teeth),  from  14  to  20 

months  after  birth. 
The    second  molars,    from    20   to   32 

months  after  birth. 
40 


Fig.  I 


Head  of  Infant,  Front  View,  showing  Primary  Dentition  at   about 
the  Seventh   Month. 

Fig.  II. 


Right  Side  of  Same 


Fig.  III. 


Left  Side  of  Same. 


THE   HUMAN   MOUTH 

The  lower  teeth  usually  appear  a  few 
weeks  in  advance  of  the  upper  ones  (Figs. 
I,  II,  III) .^  No  general  rule  can  be  for- 
mulated from  which,  however,  there  will 
not  be  marked  and  frequent  deviations. 

The  variations  are  so  marked  in  the 
dates  of  the  eruption  of  the  teeth  that  no 
two  authors  give  them  exactly  alike. 
Tubercular  and  syphilitic  children  cut 
their  teeth  very  early,  while  in  rhachitic — 
rickety — children  the  process  begins  very 
late. 

THE  CARE  OF  THE  MOUTH  OF  LITTLE 
CHILDREN. 

As  soon  as  a  child  begins  to  take  food 
its  mouth  should  receive  attention;  but 
how  few  mothers  or  nurses  ever  think  to 
cleanse  a  nursing  baby's  mouth!  Much 
if  not  all  of  the  suffering  that  some  babies 
have  to  endure  from  nursing  sore 
mouth — stomatitis — might  be  avoided  by 
a  little  care  upon  the  part  of  the  mother 
or  nurse  in  cleansing  the  mouth  of  the 
baby  after  feeding. 

Oral  hygiene,  or  oral  health,  must  be 
based  upon  prophylaxis — the  prevention 


*  Photographs  from  the  collection  in  the  Library  and 
Museum  of  the  Surgeon-General,  U.  S.  Army. 


41 


MOUTH  HYGIENE 

of  disease.  The  old,  oft-repeated,  and 
threadbare  adage,  "  An  ounce  of  preven- 
tion is  worth  a  pound  of  cure,"  is  most 
eminently  applicable  to  the  diseases  of  the 
mouth.  A  clean  mouth  is  always  a 
healthy  mouth ;  while  an  unclean  mouth  is 
always  an  unhealthy  or  diseased  mouth. 
The  mucous  membrane  of  the  mouth 
of  the  infant  is  very  tender  and  sensitive 
and  often  the  seat  of  various  superficial 
lesions,  consequently  in  cleaning  the 
mouth  of  the  infant  care  must  be  exer- 
cised not  to  injure  or  in  any  way  abrade 
its  surface.  The  gums  of  the  nursing 
infant  are  often  studded  with  so-called 
epithelial  pearls  which  are  in  reality  tiny 
retention  cysts.  These  cysts  may  dis- 
appear by  resorption  or  rupture  sponta- 
neously, and  usually  heal  without  marked 
symptoms.  These  minute  lesions,  how- 
ever, may  become  infected  from  the  pres- 
ence of  disease-producing  micro-organ- 
isms growing  in  the  mouth,  resulting  in 
ulcerated  patches  of  more  or  less  extent, 
which  are  sore  and  painful  and  frequently 
prevent  the  child  from  nursing,  and  in 
serious  cases  lead  to  grave  forms  of  disease 
and  to  sepsis. 

4« 


THE   HUMAN   MOUTH 

.  Moss  and  Epstein  ^  are  of  the  opinion 
that  *'  the  toothless  mouth  of  the  infant 
needs  no  especial  care."  From  this 
opinion  the  writer  most  vigorously  dis- 
sents. The  uncared-for  mouth  of  the 
nursing  child  is  never  free  from  particles 
of  coagulated  and  fermenting  milk,  which 
are  the  soil  upon  which  many  forms  of 
harmful  micro-organisms  grow  and  flour- 
ish. These  organisms  may  and  do  often 
attack  the  minute  lesions  above  referred 
to  and  thus  establish  a  follicular  stomati- 
tis. It  stands  to  reason,  therefore,  that, 
if  the  cause  can  be  excluded  by  keeping 
the  mouth  clean,  the  disease  vnll  be  pre- 
vented. Nearly  all  the  forms  of  stomati- 
tis that  aiFect  infants  and  small  children 
may  be  traced  to  an  unclean  condition  of 
the  mouth.  This  being  the  fact,  no  ar- 
gument is  needed  to  establish  the  relation- 
ship between  cause  and  effect. 

Stomatitis  of  Nuesixg  Childeex. — 
This  is  an  affection  that  is  rarely  seen 
in  children  that  are  fed  from  the  breast, 
unless  the  mother  or  wet  nurse  is  unclean 
and   careless   about  bathing  the  breasts 

'Diseases  of  Children,  vol.  iii,  p.  4,  1908. 

43 


MOUTH   HYGIENE 

and  nipples.  As  a  rule,  it  is  a  disease 
of  bottle-fed  children,  and  is  usually  due 
to  an  unclean,  unsanitary  condition  of  the 
feeding  apparatus  or  to  spoiled  or  in- 
fected milk.  It  is  a  mycotic — germ — dis- 
ease, and  is  therefore  easily  prevented  by 
thoroughly  boiling  all  feeding  appara- 
tus— bottles,  tubes,  nipples,  cups,  spoons, 
pans,  or  whatever  utensils  are  used  in 
preparing  the  food.  The  milk  should 
be  obtained  from  a  reliable  dairy  and 
should  be  certified  as  pure  and  free  from 
all  preservatives.  To  insure  it  from  spoil- 
ing after  delivery  it  should  be  kept  on 
the  ice  until  needed  for  use.  Mothers 
or  nurses  who  will  neglect  these  simple 
precautions  cannot  be  too  severely  criti- 
cised, for  they  are  among  the  chief  sources 
of  our  alarming  infantile  mortality. 

Cleansing  the  Mouth  of  the  In- 
fant.— This  is  best  done  by  ^\Tapping 
a  small  piece  of  sterilized  cotton  fibre 
around  the  first  finger  of  the  right  hand, 
that  has  been  carefully  washed  with  soap 
and  sterilized  water,  and,  after  moisten- 
ing the  cotton  in  sterile  water  or  a  satu- 
rated solution  of  boric  acid,  the  finger 
is  introduced  and  passed  over  the  surface 

44 


THE  HUMAN   MOUTH 

of  the  mouth  and  tongue  and  particularly 
under  the  tongue  and  between  the  gums 
and  cheeks,  as  these  are  the  places  where 
the  particles  of  coagulated  milk  are 
usually  found.  If  the  child  is  suffering 
from  a  sore  mouth,  a  physician  should 
be  consulted  at  once. 

During  the  early  stages  of  dentition  the 
mouth  should  be  carefully  inspected  every 
dav  to  see  that  there  are  no  ulcerations 
of  the  gums  at  the  points  where  the  teeth 
are  making  their  appearance.  If  the 
child  cries  when  attempting  to  nurse,  it 
is  quite  certain  that  some  form  of  stomati- 
tis— sore  mouth — is  present  and  that 
the  services  of  a  physician  are  needed. 
The  small  ailments  of  little  children 
should  never  be  neglected.  It  is  better 
to  have  the  advice  of  a  competent  physi- 
cian in  these,  as  early  treatment  may  pre- 
vent a  more  serious  condition. 

As  soon  as  the  teeth  begin  to  appear 
they  should  be  kept  scrupulously  clean. 
This  may  be  done  at  first  by  the  method 
already  described.  After  the  teeth  have 
fully  erupted,  the  tooth-brush  will  be  in- 
dicated. This  should  be  small  in  size  and 
the  bristles  soft.    Camel's  hair  makes  the 

45 


MOUTH  HYGIENE 

best  bristle  for  the  baby's  brush.  In 
applying  the  brush  especial  care  should 
be  exercised  not  to  bruise  or  in  any  way 
injure  the  gums,  or  the  mucous  membrane 
of  other  portions  of  the  mouth,  as  these 
tissues  at  this  period  are  tender  and  easily 
abraded. 

In  the  case  of  infants  the  cleansing 
of  the  mouth  twice  each  day  will  ordinarily 
be  sufficient.  This  should  be  done  morn- 
ing and  evening,  preferably  at  the  time 
of  the  bath.  After  the  teeth  have  erupted 
and  the  child  is  taking  a  mixed  diet,  the 
mouth  and  teeth  should  be  cleansed  three 
or  four  times  each  day,  preferably  on  ris- 
ing in  the  morning  and  after  each  meal, — 
on  rising,  because  the  mouth  will  be  found 
to  contain  a  greater  number  of  micro- 
organisms, as  they  have  had  an  undis- 
turbed period  of  from  six  to  ten  hours 
for  growth  and  propagation.  A  thorough 
cleansing  of  the  mouth  before  breakfast 
is  more  essential  to  good  health,  in  the 
judgment  of  the  writer,  than  all  other 
measures  of  personal  hygiene  combined. 

Persons  who  suffer  from  gastric  and 
intestinal  indigestion — which  is  often  due 
to  septic  conditions  transmitted  from  the 

4,6 


THE  HUMAN   MOUTH 

mouth — will  soon  find  marked  relief  from 
their  distressing  symptoms  if  they  observe 
this  rule.  They  should  also  visit  a  com- 
petent dentist  and  have  their  teeth  put  in 
a  healthy  condition,  by  having  the  salivary 
deposits  removed,  decayed  teeth  filled, 
abscessed  teeth  treated,  suppurating  roots 
removed,  and  teeth  suppurating  from 
pyorrhoea  alveolaris — Rigg's  disease — 
treated  or  removed. 

After  each  meal  the  teeth  are  fouled 
by  food  debris,  which  after  two  or  three 
hours  is  in  a  state  of  fermentation  or 
putrefaction,  and  acids  are  formed  which 
attack  the  enamel  and  dentine  of  the 
teeth,  resulting  in  dental  decay.  For  this 
reason,  if  no  other,  the  teeth  should  be 
brushed  and  cleansed  after  each  meal. 

The  writer  has  always  made  it  a  general 
practice  to  instruct  his  patients  in  the  care 
of  the  mouth  and  teeth.  He  has  often 
been  interrogated  by  his  little  patients 
who  thought  it  something  of  a  hardship 
to  obey  the  instructions  given  at  home  in 
relation  to  cleansing  their  teeth.  "  Doctor, 
how  often  should  I  brush  my  teeth? " 
The  question  has  usually  been  answered 
by  asking  another:  "  How  often  do  you 

47 


MOUTH   HYGIENE 

wash  your  face  and  hands?  "  "  Why, 
whenever  they  get  dirty."  "  When  do 
your  teeth  get  dirty?  "  "  Why,  I  suppose 
every  time  I  eat  anything."  "  Then  you 
should  clean  your  teeth  every  time  they 
get  dirty;  and  they  get  dirty  every  time 
you  eat  anything.  This  means  at  least 
after  each  meal,  and  as  much  oftener  as 
you  soil  them  by  food  or  candy  f  "  Can't 
I  eat  any  candy?"  "  Oh,  yes!  In  mod- 
erate degree  it  is  good  for  you;  but  you 
must  clean  your  teeth  after  eating  it,  or 
you  will  suffer  from  badly  decayed  teeth 
and  a  whole  lot  of  other  diseases  that 
sometimes  result  from  decayed  teeth." 

"  Can  I  chew  gum?  "  Certainly!  But 
do  not  do  it  in  public  places.  Chewing 
gum  will  help  to  keep  your  teeth  clean, 
but  it  will  not  take  the  place  of  the  tooth- 
brush. There  is  hardly  anything  that  is 
more  disgusting  than  to  see  a  nice-looking 
boy  or  a  pretty  girl  "  chewing  a  cud  "  in  a 
street-car  or  other  public  place.  "  Grown- 
ups "  who  have  been  well  "  brought-up  " 
of  course  need  no  hints  along  this  line. 

Little  children  should  be  taught  to  use 
the  tooth-brush  as  soon  as  the  imitative 
faculties  begin  to  develop.    This  may  be 

48 


THE  HUMAN  MOUTH 

done  by  the  mother  or  the  nurse  brushing 
her  own  teeth  before  the  child,  who  has 
been  furnished  with  an  appropriate  brush. 
The  lessons,  for  it  will  take  many,  should 
be  carefully  and  slowly  taught,  so  that 
the  child  will  comprehend  all  the  move- 
ments that  are  required  to  reach  all  parts 
of  the  mouth  and  teeth.  The  child  should 
be  taught  to  view  the  teeth  in  a  looking- 
glass  to  see  if  they  are  clean  and  compared 
with  those  of  the  mother  or  nurse.  In 
this  way  the  pride  of  the  child  is  stimu- 
lated and  rivalry  awakened  to  have  the 
nicest-looking  teeth. 

Of  course  it  is  not  expected  that 
children  of  three  years  of  age  can  be 
taught  to  care  for  their  own  teeth;  this 
must  be  the  duty  of  the  mother  or  nurse. 
A  beginning,  however,  can  be  made  at  this 
period,  and  a  habit  formed  as  the  months 
and  years  go  by,  that  will  cling  to  the 
child  through  all  after  life.  The  import- 
ance of  this  early  training  cannot  be  over- 
estimated, as  it  insures  mouth  comfort, 
good  health,  and  long  life,  barring 
accidents.  The  individual  who  has  been 
brought  up  from  early  childhood  to  give 
proper  care  to  the  cleanliness  of  the  mouth 

4  49 


MOUTH  HYGIENE 

and  teeth  is  rendered  quite  miserable  if 
for  any  reason  he  is  obliged  to  neglect 
even  for  a  single  day  this  brushing  of  the 
teeth. 

The  Mouth  of  the  Sick  Child. — At 
no  period  in  the  life  of  the  child  is  oral  hy- 
giene, or  mouth  cleanliness,  of  so  much 
importance  as  during  illness.  At  such 
time  the  secretions  of  the  mouth  are  more 
or  less  changed  and  frequently  are  de- 
cidedly acid  in  reaction;  while  the  micro- 
organisms  of  the  mouth  are  less  disturbed 
than  during  health,  and  as  a  consequence 
grow  and  propagate  more  rapidly.  Great 
damage  is  often  done  to  the  teeth  during 
a  short  illness  from  neglect  to  keep  the 
mouth  clean.  Of  course  it  should  be  un- 
derstood that  during  a  severe  illness  it 
may  not  be  possible  to  carry  out  a  careful 
and  thorough  regime  of  mouth  cleaning 
on  account  of  the  disturbance  to  the  child. 
A  little  careful  cleansing  of  the  mouth  and 
teeth w^ill  not  be  harmful  to  the  general  con- 
dition of  the  child  at  such  times,  while  in  a 
majority  of  instances  it  w^ll  prove  restful 
and  refreshing.  The  means  already  de- 
scribed for  cleansing  the  mouths  of  infants 
can  be  employed  in  these  cases  with  ease. 

50 


THE  HUMAN  MOUTH 

If  sordes — mucous  deposits  of  dark 
color — form  upon  the  teeth,  they  can 
easily  be  removed  ^\dth  a  little  stick  that 
has  been  shaped  like  a  chisel  and  charged 
with  a  little  precipitated  chalk,  and  the 
teeth  wiped  off  Avith  a  little  cotton 
moistened  in  a  saturated  solution  of  boric 
acid. 

Dental  decay  is  often  established  in 
the  mouths  of  little  children  during 
periods  of  illness,  but  much  of  this  can 
be  prevented  by  a  proper  care  of  the  oral 
cavity  during  these  times.  As  soon  as 
a  child  has  recovered  from  an  illness,  its 
teeth  should  be  carefully  examined. 
This  is  best  done  by  the  family  dentist, 
and,  if  dental  decay  has  been  established 
in  anv  of  the  teeth,  thev  should  be  treated 
and  filled  immediately  with  materials  that 
will  arrest  the  disease  and  take  so  little 
time  as  not  to  fatigue  the  child.  Many 
little  children  have  to  receive  the  atten- 
tions of  the  dentist  before  they  are  three 
years  of  age.  These  children  should  be 
treated  with  the  utmost  gentleness  and 
kindness,  so  as  to  make  it  a  pleasure  for 
them,  rather  than  a  terror,  to  have  their 
teeth  treated.    If  the  dentist  will  trouble 

51 


MOUTH  HYGIENE 

himself  to  gain  the  confidence  of  these 
little  ones,  he  will  never  have  any  trouble 
in  handling  them. 

Toothache  and  dento-alveolar  abscess 
are  not  uncommon  in  httle  children. 
Such  aifections  may  become  a  serious 
menace  to  the  health  of  the  child,  either 
through  nervous  irritation  or  septic 
conditions. 

The  pain  from  an  inflamed  dental  pulp 
or  an  acute  dento-alveolar  abscess  is  very 
excruciating  indeed,  as  some  of  our 
readers  may  know  from  a  personal  ex- 
perience. 

The  little  child  is  just  as  susceptible 
to  pain  as  the  adult,  but  has  not  the  same 
physical  power  or  nervous  stability  to 
endure  it. 


CHAPTER  IV. 

THE  HUMAN  MOUTH;  ITS  CARE  DURING 
SECOND  DENTITION. 

SECOND  DENTITION. 

After  the  completion  of  first  dentition 
at  or  about  the  age  of  three  years — the 
eruption  of  the  crowns  only  is  intended 
to  be  expressed — there  is  a  period  of  rest 
established  so  far  as  the  appearance  of 
the  second  or  permanent  teeth  is  con- 
cerned. There  is,  however,  during  this 
period  very  active  growth  or  tooth  de- 
velopment going  on  in  the  jaws,  in  the 
completion  of  the  roots  of  the  deciduous 
or  first  teeth,  and  in  the  development  of 
the  crowns  of  many  of  the  second  or 
permanent  teeth. 

The  roots  of  the  deciduous  teeth  are 
completed  in  formation  at  about  the 
following  periods  and  in  the  order  named, 
but  no  positive  rule  can  be  laid  down  from 
which  frequent  deviations  will  not  be 
observed : 

53 


MOUTH  HYGIENE 

The  central  incisors  are  completed  at 

about  the  age  of  2  years. 
The  lateral  incisors  are  completed  at 

about  the  age  of  2J  years. 
The    first    molars    are    completed    at 

about  the  age  of  2^  years. 
The  cuspids  are  completed   at  about 

the  age  of  2  J  years. 
The  second  molars  are  completed  at 

about  the  age  of  3  years. 

Figs.  IV,  V,  VI  show  the  state  of  de- 
velopment of  the  teeth  of  a  child  from 
three  to  three  and  one-half  years  of  age.^ 

During  the  period  of  active  develop- 
ment of  the  teeth  the  child  should  be 
guarded  against  all  undue  excitement,  ex- 
posure, or  indiscretions  in  feeding,  as  the 
developmental  changes  which  are  going 
on  are  taxing  the  nervous  energy  of  the 
child  to  its  full  capacity.  This  is  the 
period  when  nervous  affections  are  most 
likely  to  develop,  hence  the  necessity  for 
the  caution  above  expressed. 


^Photographs  from  the  collection  in  the  Library  and 
Museum  of  the  Surgeon-General,  U.  S.  Army. 


54 


Fig.  IV. 


Head  of  Child,  aged  3?  2  to  4  Years,  Front  Mew,  showing  Com- 
plete Primary-  Dentition  and  Secondary  Dentition  in  Various  Stages 
of  Formation. 


Flc;.    V. 


Right  Side  of  Same. 


Fig.  VI. 


Left  Side  of  Same. 


THE  HUMAN  MOUTH 

ERUPTION  OF  THE  PERMANENT  TEETH. ^ 

Normal  secondary  or  permanent  denti- 
tion begins  at  about  the  sixth  year  by  the 
eruption — cutting — of  the  jirst  molars, 
which  take  position  behind  the  second 
deciduous — milk — molars,  the  growth  of 
the  jaws  having  made  this  possible  by  in- 
creasing the  distance  between  the  second 
deciduous  molar  and  the  ascending 
ramus  —  upright  portion  —  of  the  lower 
jaw,  and  between  the  same  tooth  and  the 
tuberosity — rounded  termination — of  the 
upper  jaw. 

The  growth  of  the  jaws,  which  keeps 
pace  with  the  eruption  of  the  permanent 
teeth,  is  mainly  confined  to  an  elongation 
of  the  horizontal  ramus  of  the  lower 
jaw — ^the  portion  containing  the  teeth — 
between  the  second  deciduous  molars  and 
the  angle.  There  is  also  a  certain  amount 
of  growth  taking  place  at  the  symphy- 
sis— median  line  of  the  chin — and  in  the 
upper  jaw  at  the  median  and  intermaxil- 
lary sutures — median  line  of  the  upper 
jaw  and  a  lateral  line  passing  between  the 
lateral  incisors  and  cuspid — miscalled  eye- 

'  Marshall's  Operative  Dentistry,  third  edition,  p.  79, 

55 


MOUTH  HYGIENE 

teeth — and  also  in  the  interstitial  sub- 
tance — body  of  the  jaws. 

In  this  connection  it  will  be  well  to 
state  that,  during  the  process  of  eruption 
of  the  permanent  teeth  of  the  child,  the 
family  dentist  should  be  frequently  con- 
sulted, so  that  he  may  correct  at  the 
earliest  moment  any  tendency  to  a  mal- 
position of  the  teeth.  It  is  a  mistake  to 
postpone  such  operation  until  the  teeth 
have  all  erupted,  as  used  to  be  recom- 
mended not  long  ago. 

The  first  permanent  molar  has  the  mis- 
fortune frequently  to  be  considered,  or 
rather  mistaken  for,  a  deciduous  or  milk 
tooth,  and,  because  of  the  mistaken  notion 
of  many  otherwise  intelligent  people,  that 
the  first  teeth  should  receive  no  dental 
attention  because  they  are  only  temporary 
organs  soon  to  be  lost  by  a  natural  pro- 
cess, these  teeth  (the  first  permanent 
molars)  are  often  allowed  to  decay,  until 
they  are  past  saving  by  any  means  known 
to  the  dentist,  and  have  to  be  extracted. 
A  greater  crime  against  the  dental  per- 
fection of  the  child  could  not  be  com- 
mitted, and  the  writer  wishes  he  could 
proclaim  this  fact  from  the  house-tops. 

56 


THE  HUMAN  MOUTH 

The  first  permanent  molars  are  the  key- 
stones to  the  dental  arches,  and  when  they 
are  extracted  the  perfection  and  symmetry 
of  the  arches  are  ruined,  the  teeth  assume 
irregular  positions,  resulting  in  malocclu- 
sion and  more  or  less  loss  of  the  mastica- 
tory function. 

Children  whose  first  permanent  molars 
have  been  neglected  until  they  are  badly 
decayed  have  usually  bad  digestion,  be- 
cause these  teeth  have  been  so  sensitive  or 
painful  as  to  make  proper  mastication 
impossible,  hence  the  food  has  been 
swallowed  before  it  has  been  properly 
triturated  and  mixed  with  the  saliva,  thus 
producing  indigestion,  malassimilation, 
headache,  general  nervous  irritability,  and 
sluggish  minds.  Children  of  this  class 
make  up  the  large  majority  of  the  "  back- 
ward "  children  in  our  public  and  private 
schools.  Furthermore  these  children  have 
suffered  very  considerably  in  a  large 
majority  of  cases  from  toothache,  or  ab- 
scessed teeth  and  swollen  faces,  which  have 
robbed  them  of  sleep  and  rendered  them 
nervous,  peevish,  ill-tempered,  or  posi- 
tively ill;  and  this  many  times  with  little 
or  no  sympathy  from  those  responsible 

57 


MOUTH  HYGIENE 

for  the  upbringing  of  the  child,  and  who 
have,  through  ignorance  of  the  conditions 
and  the  real,  vital  suffering  through  which 
the  children  have  passed,  considered  it  as 
one  of  the  children's  troubles  that  must 
be  endured.  Or,  when  the  cries  of  the 
child  have  so  disturbed  the  sleep  of  the 
household  that  "  endurance  was  no  longer 
possible,"  the  little  sufferer  has  been 
hurried  away  to  the  dentist  and  the  tooth 
removed. 

The  following  table  gives  a  fairly  cor- 
rect idea  of  the  time  and  the  order  in  which 
the  eruption  of  the  permanent  teeth  takes 
place.^  These  figures  are  subject  to 
slight  variations  to  suit  the  individual 
case : 

First  molars  ....  5    to    7  years  of  age. 

Central  incisors,  6j  to    8  years  of  age. 

Lateral  incisors,  7    to    9  years  of  age. 

First  bicuspids .  .  9    to  1 1  years  of  age. 

Second  bicuspids,  10    to  12  years  of  age. 

Cuspids 11    to  14  years  of  age. 

Second  molars  .  .  11^  to  13  years  of  age. 

Third    molars   .  .  16    to  21  years  of  age, 

or  at  any  period  later. 


3  Marshall's  Operative  Dentistry,  third  edition,  p.  81. 

58 


Fig.  VII. 


Adult  Head,  showing  Complete  Secondary  Dentition.    (After  Crj-er.) 


£   S 


•B   £     ££ 


THE   HUMAN   MOUTH 

"  The  third  molars  not  infrequently  fail 
to  appear  at  all.  They  are  usually  de- 
veloped, but  remain  in  their  crypts  in  the 
jaws  for  lack  of  space  in  the  dental  arch 
to  accommodate  them,  or  are  so  malposed 
that  their  eruption  is  difficult  or  im- 
possible." 

The  lower  teeth  usually  precede  the 
upper  ones  of  the  same  class  two  or  three 
months,  but  this  rule  is  subject  to 
variation. 

SHEDDING   THE   DECIDUOUS    TEETH. 

The  exuviation  or  shedding  of  the 
deciduous  or  milk  teeth  is  a  peculiar 
physiologic  process — resorption — which 
causes  a  gradual  dissolving  or  melting 
away  of  the  roots  of  the  teeth  until  noth- 
ing is  left  but  the  crown,  which,  from 
lack  of  further  attachment  to  the  jaw  and 
gum,  falls  out. 

This  process  begins  in  the  central  in- 
cisors in  about  a  year  or  a  little  more 
after  the  complete  formation  of  their  roots. 
Figs.  VII,  VIII, — viz.,  in  the  middle  or 
latter  part  of  the  third  year, — but  is  not 
completed  until  about  the  seventh  year, 
when  the  crowns  fall  out  from  lack  of  sup- 

59 


MOUTH   HYGIENE 

port,  and  the  permanent  central  incisors 
take  their  place.  Although  these  teeth  are 
considerably  wider  than  those  which  they 
replace,  the  compensating  growth  of  the 
jaw  has  been  such  that  there  is  usually 
room  for  them  to  take  their  normal  posi- 
tion. IThe  lateral  incisors  are  attacked 
a  few  months  later  and  are  shed  at  about 
seven  and  one-half  to  eight  years  of  age, 
the  permanent  laterals  immediately  tak- 
ing their  place.  The  process  begins  in  the 
first  deciduous  molars  at  the  age -of  six 
and  one-half  to  seven  years,  terminating 
at  about  the  tenth  year ;  they  are  replaced 
by  the  first  permanent  bicuspids.  The 
second  molars  are  attacked  at  from  six 
months  to  a  year  later,  the  process  being 
completed  at  about  the  eleventh  year,  and 
are  replaced  b^^  the  second  permanent 
bicuspids.  The  cuspids  are  usually  the 
last  of  the  deciduous  teeth  to  be  shed, 
although  many  instances  will  be  observed 
in  w^hich  they  will  be  shed  before  the 
second  molars.  The  process  begins  in  the 
cuspids  at  about  the  eighth  year,  and  is 
not  usually  completed  until  the  twelfth 
year  or  even  later.  These  teeth  are  re- 
placed by  the  permanent  cuspids.     The 

60 


THE   HUMAN   MOUTH 

location  and  eruption  of  the  first  perma- 
nent molars  have  already  been  described  as 
situated  directly  behind  the  second  decid- 
uo'us  molars  and  they  are  the  most  im- 
portant teeth  in  the  permanent  dental 
arch.  These  teeth  being  members  of  the 
permanent  denture  are  never  shed,  which 
is  a  fact  that  should  be  more  definitely 
fixed  in  the  lay  mind,  if  the  children  who 
are  born  in  the  future  are  to  maintain 
a  normal  symmetry  of  the  dental  arch  and 
of  the  face. 

At  about  the  twelfth  year  of  age  the 
second  permanent  molars  are  erupted 
directly  behind  the  first  permanent  mo- 
lars, and  at  the  sixteenth  to  the  twenty- 
first  year  of  age  the  third  permanent 
molars — miscalled  ^^isdom  teeth — take 
their  place  directly  behind  the  second  per- 
manent molars,  thus  completing  the  nor- 
mal adult  dental  apparatus. 

THE   CARE   OF  THE   PERMANENT   TEETH. 

This,  primarilij,  is  the  consideration  of 
all  those  means  wliich  may  be  employed 
to  prevent  diseases  of  the  teeth  and  the 
mouth,  and,  secondarilij ,  of  those  means, 
medical,  surgical,  and  mechanical,  which 

61 


MOUTH  HYGIENE 

are  employed  to  cure  disease  and  to  re- 
store parts  that  have  been  lost  by  disease, 
accident,  or  by  design.  The  former  only 
will  come  within  the  province  of  oral  hy- 
giene, and  is,  therefore,  the  only  branch 
of  the  subject  which  will  be  considered  in 
these  pages. 

The  highest  aim  of  the  healing  art  is 
not  the  cure  of  disease,  but  its  'prevention. 
The  Chinese  high-class  people  employ 
their  physicians  by  the  year  to  keep  them 
well,  to  prevent  sickness.  When  any 
member  of  the  family  is  ill,  the  pay 
stops — the  doctor  has  been  derelict  in  his 
duties. 

The  highest  aim  of  the  dentist  should 
be  to  prevent  the  development  of  disease 
within  the  oral  cavity,  and  to  check  its 
ravages  at  the  earliest  possible  moment, 
so  that  the  attendant  dangers  may  be  re- 
duced to  the  minimum.  In  order  to  ac- 
complish this  much-to-be-desired  result, 
frequent  examinations  of  the  mouth  and 
teeth  at  stated  intervals,  with  explicit  in- 
structions in  the  various  means  which  may 
be  adopted  to  keep  the  mouth  and  teeth 
in  an  hygienic  condition,  will  be  absolutely 
necessary. 

62 


THE   HUMAN   MOUTH 

The  system  of  frequent  periodical  ex- 
aminations, to  be  most  effective,  should 
be  instituted  in  early  life,  commencing 
with  the  little  children  as  soon  as  the  de- 
ciduous teeth  have  erupted.  In  the 
families  of  the  well-to-do  and  the  rich, 
there  is  no  difficulty  in  the  wav  of  its 
accomplishment  as  soon  as  they  appre- 
ciate its  value  as  a  health-gi\^ng  practice. 
Xot  so  ^^ith  the  respectable  poor  and  in- 
digent, or  the  children  of  the  slums,  who, 
because  of  the  poverty  or  ignorance,  or 
both,  of  their  parents,  rarely  or  never 
receive  such  attentions. 

It  is  hoped,  therefore,  that  the  move- 
ment to  establish  free  dental  clinics  for 
the  benefit  of  the  indigent  poor  may,  in 
the  light  of  our  advanced  and  more  in- 
telligent appreciation  of  oral  hygiene  as 
a  public-health  measure  by  the  official  and 
the  general  public,  prove  successful,  and 
that  the  care  of  the  mouth  and  the  teeth 
may  become  as  fullv  recognized  as  a 
beneficent  service  as  is  now  the  case  when 
illness  brings  this  same  class  of  people 
to  our  public  hospitals  and  sanitariums. 
Free  dental  clinics  might  be  established 
as  out-patient  departments  in  every  pub- 

63 


MOUTH   HYGIENE 

lie  hospital  and  sanitarium  in  the  country 
with  but  little  additional  expense  to  the 
public  treasury.  The  lestablishment  of 
the  great  Forsyth  Dental  Infirmary  in 
Boston,  Mass.,  is  a  most  magnificent  char- 
ity, and  we  hope  is  only  the  forerunner 
of  many  like  enterprises  that  will  be  es- 
tablished by  wealthy  and  philanthropic 
people.  The  poor  and  needy  are  always 
with  us,  thus  making  our  duty  plain. 

Every  child  that  is  bom  into  the  world 
has  the  right  given  of  God,  to  be  born 
with  a  healthy  body,  a  healthy  mind,  and 
healthful  moral  tendencies.  It  also  has 
the  right  to  be  protected  from  diseases 
and  deformities  of  body  and  mind  and 
from  moral  degradation.  If  parents  fail 
in  these  duties,  then  the  responsibility 
rests  with  the  State.  In  some  instances 
this  responsibility  is  recognized  and  the 
children  protected  against  the  ignorance, 
the  indiiFerence,  the  cupidity,  or  the  in- 
humanity of  the  parents  or  guardians. 
The  medical  inspection  of  the  public- 
school  children,  recently  organized  and 
put  into  operation  in  several  of  the  States, 
is  a  recognition  of  this  obligation.  But 
it  must  go  much  further  than  at  present 

64 


THE  HUMAN   MOUTH 

contemplated,  and  should  provide  medical, 
surgical,  and  dental  treatment  for  such 
children  as  need  it,  and  whose  parents 
cannot  afford  to  pay  the  expense  of  such 
treatment,  while,  upon  the  other  hand, 
those  who  can  aiFord  it  should  be  com- 
pelled by  stringent  law  to  do  so.  The 
law  compels  a  father  to  provide  food 
and  clothing  for  his  children;  why  not, 
then,  proper  medical,  surgical,  and  den- 
tal treatment? 

PHYSICAL  DEFECTS  TEND  TO  MORAL 
ABERRATIONS. 

Many  a  child  becomes  ill-tempered, 
morose,  cruel,  quarrelsome,  vindictive,  and 
untruthful  because  of  the  constant  irrita- 
tion of  phj^sical  defects,  not  the  least  of 
which  are  irritations  from  dental  and  oral 
iiseases  and  malformations.  Many  a  child 
goes  wrong  morally  when  it  discovers  it 
is  physically  deficient  or  deformed.  A 
crooked  disposition  often  goes  with  a 
crooked  back. 

An  irregular  set  of  teeth,  a  malformed 
jaw,  a  hare-lip,  or  a  cleft-palate  often 
destroys  the  happiness  of  a  sensitive  cliild 

5  65 


MOUTH  HYGIENE 

by  making  him  the  butt  of  ridicule  of 
his  associates,  and  psychologically  tends 
to  pervert  an  other^^ise  sweet  and  loving 
disposition,  turning  it  into  one  in  which 
hatred  and  vindictiveness  are  its  leading 
characteristics. 

The  State  cares  for  the  blind,  the  deaf 
and  dumb,  the  imbecile,  the  epileptic,  and 
the  crippled  children.  Why  should  it  not 
care  for  these  other  children  and  give  them 
a  fair  chance  in  life  ? — a  fair  chance  to  be- 
come healthful,  self-respecting,  and  noble 
citizens. 

Nearly  every  state  that  has  established 
medical  inspection  of  the  public-school 
children,  including  the  District  of  Colum- 
bia, has  included  dental  inspection. 

The  school  dental  clinics  so  far  estab- 
lished have,  as  a  rule,  been  supported  by 
volunteer  subscription  and  service  on  the 
part  of  philanthropic  people,  dental  so- 
cieties and  individual  dentists. 

THE  XEED  OF  MOUTH  CLEANLINESS. 

Cleanliness  of  the  mouth  and  teeth  is 
the  greatest  of  all  prophylactic  measures 
which  can  he  instituted  against  dental 
decay, 

66 


THE   HUMAN  MOUTH 

This  statement  needs  no  verification, 
for  it  should  be  patent  to  every  one  of 
even  limited  observation  that  dental  decay 
rarely  ever  occurs  upon  the  smooth  sur- 
faces of  the  teeth  which  are  fully  exposed 
to  the  friction  of  foods  in  mastication 
and  the  cleansing  action  of  the  tongue, 
lips,  cheeks,  and  the  oral  secretions. 

The  prevention  of  dental  decay  should 
therefore  be  directed  to  securing  as  nearly 
as  possible  perfect  cleanliness  of  the 
mouth,  for  this  implies  the  removal  and 
destruction  of  zymogenic — ferment-pro- 
ducing— micro-organisms  of  the  mouth, 
which  are  the  local  cause  of  dental  decay, 
together  with  their  acid  products  and  all 
fermentable  material. 

Children  should  be  early  taught  the 
value  and  the  necessity  of  keeping  their 
teeth  clean.  But  this  is  not  always  an 
easy  task  to  accomplish,  for  usually  it  is 
incomprehensible  to  them.  It  therefore 
becomes  necessary^  in  most  cases  to  adopt 
some  other  means  to  accomplish  the  end. 
Sometimes  it  may  be  done  by  stirring  up  a 
spirit  of  rivalry  among  the  children  of  the 
family  or  between  mother  or  nurse  and  the 
child,  as  to  who  will  have  the  cleanest 

67 


MOUTH  HYGIENE 

looking  teeth  every  day.  Or  it  may  be 
necessary  to  stimulate  the  pride  of  the 
little  one  to  have  the  cleanest  and  nicest 
looking  teeth  of  any  member  of  the  class 
at  school.  On  the  other  hand  it  may  be 
sufficient  to  call  the  attention  of  the  child 
to  a  pictm^e,  such  as  that  of  Fig.  IX,  which 
shows  a  dirty  mouth  and  teeth,  and  then 
compare  it  with  Fig.  X,  which  shows  a 
clean  and  healthy  mouth.  Pictures  often 
produce  a  most  vivid  and  lasting  impres- 
sion upon  the  mind  of  a  child  and  are 
therefore  often  more  valuable  in  teaching 
a  lesson  and  impressing  a  truth  than  any 
other  methods  that  may  be  employed. 

The  human  mouth  is  the  habitat  of 
large  numbers  of  bacteria,  as  already 
stated  upon  a  previous  page.  The  non- 
pathogenic bacteria  make  up  the  bulk  of 
these  organisms.  Pathogenic  bacteria  are 
really  few  in  number  but  all  or  nearly  all 
of  them  are  found  in  the  mouth,  even  in  a 
clean  mouth,  but  they  are  always  much 
more  abundant  in  an  unclean  or  dirty 
mouth. 

The  value  of  perfect  oral  cleanliness  is 
not  generally  understood  or  appreciated 
by  the  public.     Most  people  brush  their 

68 


Fig.  IX. 


Showing  Unclean  Mouth  and  Teeth. 
Fig.  X. 


Showing  the  Same  After  the  Teeth  had  been  Cleaned  and  Polished. 


THE  HUMAN  MOUTH 

teeth  for  purely  cosmetic  reasons,  not  to 
prevent  disease.  It  therefore  becomes  the 
duty  of  every  dental  practitioner  so  to 
instruct  his  clients  in.  the  need  of  oral 
hygiene  as  a  preventive  measure  against 
disease,  and  the  means  by  which  they  may 
secure  this  condition,  that  they  will  fully 
appreciate  its  value,  and  intelligently 
strive  to  carry  out  the  instruction  in  all 
of  its  details. 

These  measures  should  consist  of: 

First.  Instruction  to  parents  and 
nurses  in  the  proper  care  of  children  in 
relation  to  the  general  measures  of  hy- 
giene— food,  clothing,  exercise,  breathing, 
the  value  of  pure  air  in  the  nursery  and 
plenty  of  it — that  the  best  possible  de- 
velopment of  the  whole  body,  and  conse- 
quently of  the  .dental  organs,  may  be 
secured. 

Second.  In  such  a  resfular  and  svstem- 
atic  mechanical  cleansing  of  the  teeth  and 
the  mouth  that  the  acid-producing  bac- 
teria and  the  fermentable  substances  upon 
which  they  grow  may  be  thoroughly  re- 
moved, or  reduced  to  the  minimum. 

Third.  By  prohibiting  or  so  limiting 
the  consumption  of  such  foods  and  con- 

69 


MOUTH  HYGIENE 

fections  as  furnish  the  material  for  acid 
formation,  that  the  chief  source  of  lactic 
acid  may  be  eliminated  or  greatly 
reduced. 

HOW   TO  CLEAN   THE  TEETH. 

A  good  brush,  a  spool  of  floss  silk, 
a  tongue-scraper,  and  plenty  of  pure 
water  are  all  that  are  needed,  ordinarily, 
for  cleansing  the  mouth  and  the  teeth. 
Tooth-powders  or  pastes  may  sometimes 
be  necessary  to  keep  the  teeth  bright  and 
clean;  but  when  the  individual  habitually 
brushes  the  teeth  three  or  four  times  each 
day,  powders  and  pastes  are  unnecessary. 
When  the  teeth  are  neglected,  and 
brushed  only  occasionally — for  instance, 
when  going  out  to  dine  or  to  spend  the 
evening — dentifrices  will  most  likely  be 
needed  and  plentifully  applied  to  make 
the  teeth  look  passably  respectable  and 
partially  to  correct  the  accompanpng  un- 
wholesome fetid  breath. 

In  using  the  tooth-brush  the  teeth 
should  be  brushed  both  crosswise  and  up 
and  down — that  is,  in  the  direction  of 
the  long  axis  of  the  teeth, — ^with  a  rotary 

70 


THE  HUMAN  MOUTH 

motion,  from  the  gums  to  the  free  ends 
of  the  teeth.  This  rotating  motion  per- 
mits the  bristles  of  the  brush  to  pass  be- 
tween the  dental  interspaces  of  the  teeth 
and  removes  the  particles  of  food  that  have 
lodged  in  or  have  been  forced  into  these 
spaces.  These  are  the  locations  most  fre- 
quently attacked  by  decay.  All  the  sur- 
faces of  the  teeth  can  be  reached  with 
a  properly  shaped  tooth-brush  (Figs. 
XI  and  XII) .  A  brush  of  this  form  per- 
mits every  tooth  to  be  reached,  including 
the  last  molars,  and  the  surfaces  of  the 
teeth  next  to  the  tongue  and  the  roof  of 
the  mouth.  Tooth-brushes  are  usually 
made  in  three  grades,  "  soft,"  "  medium," 
and  "  hard."  The  "  medium  "  brush  is 
best  for  general  use.  The  "  soft  "  brush  is 
usually  too  soft  to  be  effective  in  removing 
the  food  from  the  interdental  spaces,  as 
the  bristles  double  up  instead  of  passing 
into  the  interspaces;  while  the  "hard" 
brush  is  frequently  harmful  to  dehcate 
gums,  by  reason  of  the  fact  that  the 
bristles  are  so  stiff  and  wiry  as  to  cause 
abrasions  and  bleeding,  and  this  invites 
infection  and  often  is  the  starting-point  of 
an  acute  stomatitis. 

71 


MOUTH  HYGIENE 

The  Cake  of  the  Tooth-brush. — It 
is  important  that  the  tooth-brush  be  kept 
in  a  sterile  condition,  that  all  danger  from 
infection  may  be  obviated.  This  may  be 
accomplished  in  the  home  with  little 
trouble.  The  brush  should  be  carefully 
washed  after  using,  with  clean  water,  and 
then  immersed  in  ethyl  alcohol.  A  glass 
jar.  or  bottle  of  suitable  size,  fitted  with 
a  screw  top,  is  the  best  form  of  container 
for  the  purpose  that  has  been  found,  and 
does  away  with  the  necessity  for  boiling 
the  brush. 

In  a  neglected  and  unclean  mouth  the 
gums  are  often  in  a  state  of  considerable 
congestion  and  inflammation;  under  such 
circumstances  the  softest  brush  will  cause 
hemorrhage,  but  after  a  time,  if  the  brush- 
ing is  persisted  in,  the  tendency  to  hem- 
orrhage will  cease,  and  the  gums  will  as- 
sume a  healthy  appearance,  provided  the 
salivary  deposits — tartar — have  been  re- 
moved and  the  surfaces  of  the  teeth  prop- 
erly polished. 

Floss  silk  is  now  put  up  in  very  neat 
little  containers  (Figs.  XIII  and  XIV) 
suitable  for  the  toilet  table,  or  to  be  carried 
in  the  vest-pocket  or  in  the  chatelaine. 

72 


Fig.  XI. 


Watkins  Adult  Tooth-l)ru.sh. 


Watkins  Child's  Tooth-brush, 


Fig.  XII. 


Q.^"  ^    ""^^    CLEAN  TOOTH°NEVeH     OECttYS"  ^\^/ 


Prophylactic   Tooth-brush. 


Fig.  XIV. 


Floss  Silk  Holder. 


Fig.  XIII. 

AN  O 

OP  OF 

ifll^nli 

CUTTING 

CA  P 

I^GHli 

foEVlCE 

Floss  Silk  Holder. 


THE  HUMAN  MOUTH 

The  use  of  "  silk  floss  ''  as  an  ad- 
junct to  the  tooth-brush  is  of  great  value 
in  cleansing  the  dental  interspaces  of  such 
particles  of  food  as  the  tooth-brush  has 
failed  to  remove.  The  silk  should  be  first 
waxed  and  then  cut  in  pieces  six  to  eight 
inches  in  length,  and  these  passed  between 
the  teeth,  the  ends  crossed,  and  by  a  back- 
ward and  forward  movement  made  to  pass 
over  the  approximating  surfaces  of  the 
teeth  from  the  gums  to  the  cutting  edges 
or  the  grinding  surfaces.  Care  should  be 
used  not  to  wound  the  gums  by  forcing  the 
silk  upon  them  with  too  great  energy- . 

Tooth-picks  are  also  useful  in  removing 
food  debris  and  vegetable  and  animal 
fibres  that  have  been  forced  between  the 
teeth  and  are  impinging  upon  the  gums. 
Such  masses  of  food  should  never  be  al- 
lowed to  remain  impinging  upon  the 
gum  for  a  longer  time  than  one  can  reach 
a  convenient  place  for  their  removal,  as 
great  injury  m.ay  be  done  to  the  delicate 
festoon  that  fills  the  base  of  the  dental 
interspace  and  gives  to  the  gums  their 
beautiful  symmetry.  The  loss  of  the  gum 
festoons  gives  the  appearance  of  age  or 
senility  to  the  teeth ;  they  should  therefore 

73 


MOUTH  HYGIENE 

be  protected  from  injury  and  loss.  Un- 
skillful use  of  the  tooth-pick  is  often  very 
harmful  to  the  gum  festoons,  and  for  that 
reason  it  should  be  rarely  used.  Metal 
tooth-picks  are  unpleasant  to  use,  espe- 
cially if  the  individual  has  metal  fillings 
in  the  teeth,  because  when  two  dissimilar 
metals  come  together  in  the  mouth  a 
galvanic  shock  is  the  result;  furthermore, 
they  can  rarely  be  made  thin  enough  to 
pass  properly  between  the  teeth.  Wooden 
tooth-picks  are  an  abomination,  for  they 
are  too  thick  and  clumsy  to  enter  the  den- 
tal interspaces,  and  they  often  break  off 
between  the  teeth  or  split  and  leave 
slivers  in  the  gums  that  cause  inflamma- 
tion, suppuration  and  sometimes  sepsis. 

The  only  tooth-picks  that  should  be 
used  in  the  mouth  are  thin,  sterilized 
quills,  made  from  suitable  feathers. 
These  can  be  used  without  injury  to  the 
tissues,  and,  if  scraped  thin  enough,  will 
readily  pass  between  the  teeth ;  while  they 
are  sufficiently  rigid  to  remove  vegetable 
and  animal  fibres  that  may  have  lodged 
between  the  teeth. 

The  tongue  is  often  in  a  very  unsani- 
tary condition.    This  organ  should  receive 

74 


Fig.  XV. 


Tongue  Scraper. 


THE  HUMAN  MOUTH 

as  much  attention  as  is  given  to  the  teeth 
to  keep  them  clean.    The  dorsum — upper 
surface — of  the  tongue  is  supplied  with 
numerous  minute  papillse  and  tiny  grooves 
or  depressions  surrounding  them,  which 
are     the     lodging-places     for     particles 
of    food     debris     and    are    the     breed- 
ing-ground for  vast  numbers  of  micro- 
organisms.    The  dorsum  of  the  tongue 
should      be      cleaned      every      morning 
by  scraping  with  a  suitable  instrument 
made  of  ivory,  bone,  or  celluloid.    This  in- 
strument, known  as  a  tongue-scraper,  is 
shown  in  Fig.  XV.    It  is  about  six  inches 
in  length  and  has  a  loop  or  bow  at  one  end. 
In  using  this   instrument,   it  should   be 
carried  well  back  in  the  mouth,  to  the  root 
of  the  tongue,  and  then  drawn  forward 
upon  the  surface  to  the  tip  of  the  organ. 
This   should  be  repeated   several  times. 
The  Japanese  provide  a  tongue-scraper 
with  every  tooth-brush  sold.     This  would 
be  a  good  practice  for  all  tooth-brush 
manufacturers  to  adopt.    The  tooth-brush 
may  be  used  for  the  same  purpose,  but  it 
is  inferior  to  the  scraper  and  less  comfort- 
able to  use. 

The  writer  has  occasionally  lost  a  client 

75 


MOUTH  HYGIENE 

by  his  insistences  that  greater  care  must 
be  exercised  upon  the  part  of  the  individ- 
ual in  keeping  the  mouth  and  teeth  clean 
if  he  is  to  be  retained  as  the  dental 
attendant,  or  because  he  declined  to  act 
the  part  of  a  scavenger  for  the  removal 
of  such  accumulation  as  could  be  easily 
gotten  rid  of  by  the  use  of  the  tooth-brush 
before  presenting  for  treatment. 

Many  ladies  who  are  pinks  of  perfec- 
tion and  neatness  in  their  toilet,  wear  beau- 
tiful clothes,  and  expensive  diamonds  and 
pearls  about  their  necks,  are  wofully 
negligent  of  mouth  cleanliness,  neglecting 
the  pearls  within  their  mouths  until  they 
turn  black  and  unsightly  from  neglect  and 
disease — ^through  an  unreasoning  fear  of 
dental  treatment — and  constantly  carry 
about  with  them  conditions  infinitely  more 
dangerous  to  their  individual  health  and 
more  disgusting  to  their  associates  than 
the  sight  and  smell  of  an  open  sewer. 

MOUTH-WASHES. 

These  agents  are  of  little  value  except 
as  toilet  articles.  They  have  little  or  no 
inhibitive  effect  upon  the  micro-organ- 
isms that  inhabit  the  mouth.    An  antisep- 

76 


THE  HUMAN  MOUTH 

tic  of  sufficient  strength  to  inhibit  the 
growth  of  any  mouth  bacterium  would 
prove  so  irritating  to  the  mucous  mem- 
brane that  it  could  not  be  borne.  The 
only  real  value  of  a  mouth-wash  is  to 
assist  in  keeping  the  mouth  clean,  in  con- 
junction with  the  tooth-brush,  to  correct 
or  disguise  an  offensive  breath,  or,  by  its 
cooling  and  detergent  effect,  to  allay  an 
inflammatory  condition  of  the  mouth  in- 
duced by  neglect  or  disease.  As  a  means 
of  preventing  the  growth  of  mouth  bac- 
teria or  of  preventing  decay  they  are  "  a 
delusion  and  a  snare."  ]Mouth  cleanliness, 
produced  by  mechanical  means,  is  the  only 
preventive  of  these  conditions.  The  mere 
rinsing  of  the  mouth  with  fluids  does  not, 
and  cannot,  remove  the  food  deposits  left 
upon  the  teeth  after  mastication. 

Clean  teeth  do  not  decay, — A  clean 
mouth  and  a  clean  body  are  the  best  safe- 
guards against  disease.  Guard  well  the 
health  of  the  mouth  and  the  stomach  will 
take  care  of  itself.  Keep  the  mouths  and 
teeth  of  the  children  in  a  clean  and  healthy 
condition  and  the  undertaker  will  call  less 
often  at  your  door. 

77 


CHAPTER  V. 

THE  HUMAN   MOUTH;  ITS  CARE 
DURING  ILLNESS. 

At  no  time  in  the  history  of  the  individ- 
ual is  the  proper  hygienic  care  of  the 
mouth  of  so  much  importance  as  when 
suffering  from  severe  and  prolonged  ill- 
ness; especially  the  continued  and  inter- 
mittent fevers,  tuberculosis,  acute  articu- 
lar rheumatism,  nervous  prostration,  and 
during  pregnancy  and  lactation. 

During  these  periods  there  is  always 
a  marked  change  in  the  character  of  the 
oral  secretions:  instead  of  being  neutral 
in  reaction  they  are  almost  invariably  acid, 
while  the  patient  will  often  complain  of  a 
"  bad  taste  in  the  mouth."  These  condi- 
tions are  due  to  perverted  nutrition, 
faulty  metabolism  and  the  action  of  the 
mouth  bacteria. 

Rapid  dental  decay,  gingivitis — in- 
flammation of  the  gums — and  stomatitis 
are  common  complications,  or  rather 
sequelae,  of  severe  illness. 

Rapid  dental  decay  is  almost  always 

78 


THE  HUMAN  MOUTH 

a  concomitant  affection  of  typhoid  fever 
and  rheumatic  fever.  The  same  condi- 
tion is  also  very  frequently  associated  with 
pregnancy  and  lactation.  These  facts 
are  well  known  to  dental  surgeons,  and 
many  cases  might  be  cited  to  substantiate 
the  statement. 

By  way  of  illustration,  the  writer  will 
briefly  describe  three  typical  cases  from 
his  own  practice: 

Mr.  J.  K.,  aged  19  years,  in  the  best 
of  health,  had  his  teeth  put  in  good  con- 
dition before  entering  college.  He  had 
had  but  little  dental  decay;  always  from 
early  childhood  had  taken  nice  care  of  his 
teeth  and  mouth.  Was  considered  by  the 
writer  as  one  of  his  banner  patients. 
Two  months  after  entering  college,  he 
was  stricken  with  typhoid  fever  in  a  severe 
form.  Three  months  later  he  returned  to 
his  home  to  convalesce,  and  at  once  re- 
ported complaining  of  sensitiveness  of  the 
teeth  and  of  decay.  Upon  a  critical  ex- 
amination, fourteen  cavities  of  decay  were 
found,  located  at  the  gum  margins  and 
upon  the  approximal  surfaces. 

Miss  E.  L.,  aged  14  years,  of  robust 
health,  had  beautiful  and  almost  perfect 

79 


MOUTH  HYGIENE 

teeth,  with  very  few  fillings.  Mouth  care- 
fully examined  just  before  sailing  for 
Paris  to  enter  a  fashionable  school.  Six 
months  later  was  stricken  with,  inflamma- 
tory rheumatism,  and  for  several  weeks 
her  life  hung  in  the  balance.  Upon  re- 
covery she  visited  a  noted  Paris  dentist 
for  relief  of  very  severe  pain  and  decay 
at  the  gum  margins  of  nearly  all  her 
teeth.  Only  temporary  treatment  was 
given  her  at  this  time,  as  her  parents  were 
to  bring  her  home  as  soon  as  strong- 
enough  to  make  the  ocean  voyage.  She, 
however,  suffered  a  relapse  and  died  in 
Paris. 

JNIiss  H.  C,  aged  25  years.  JNIilliner 
by  occupation;  health  had  been  good. 
Teeth  were  in  good  condition  and  regu- 
larly cared  for.  Had  a  number  of  fillings, 
all  in  good  condition  at  last  visit.  Soon 
after  was  stricken  ^^dth  pneumonia  and 
was  desperately  ill  and  made  a  slow  re- 
covery. Acute  pulmonary  tuberculosis 
developed  before  she  was  able  to  leave  her 
room,  and  from  which  she  died  six  months 
later.  During  the  last  four  months  of 
her  illness  her  teeth  were  attacked  with 
rapid  decay,  which  affected  nearly  every 

80 


THE  HUMAN  MOUTH 

metal  filling  in  her  mouth  and  established 
several  new  cavities,  necessitating  many 
visits  to  her  bedside  to  give  her  relief  from 
pain. 

In  nearly  all  abnormal  affections  and 
conditions  the  saHvary  secretions  are 
hyper-acid,  and  as  a  result  of  this  the 
teeth  are  particularly  prone  to  rapid 
dental  decay.  The  same  is  true  of  chil- 
dren suffering  from  severe  and  prolonged 
cases  of  scarlet  fever,  diphtheria,  measles, 
and  gastro-intestinal  affections.  The 
writer  also  observed  while  on  duty  in  the 
Philippine  Islands  that  our  soldiers  af- 
flicted with  amoebic  dvsenterv  and  sprue 
were  very  prone  to  rapid  dental  decay. 

The  signs  of  rapid  dental  deca}^  are  a 
whitening  of  the  enamel  at  the  cervices — 
necks — of  the  teeth  at  the  gum  margins, 
giving  a  chalky  appearance  to  this  portion 
of  the  teeth,  a  whitened  or  chalkv  zone 
around  present  cavities  of  decay,  and  the 
formation  of  chalky  appearing  zones  upon 
the  approximating  surfaces  of  the  teeth 
at  the  points  of  lateral  contact. 

Gingivitis,  or  inflammation  of  the 
gums,  is  usually  due  either  to  an  unclean 
condition  of  the  mouth,  causing  an  in- 

6  81 


MOUTH  HYGIENE 

fection,  the  presence  of  salivary  calcu- 
lus— tartar — or  to  a  faulty  metabolism. 

Stomatitis,  or  inflammation  of  the 
mouth,  is  generally  due  either  to  infection 
from  an  unclean  mouth,  to  local  irrita- 
tion from  substances  taken  into  the  mouth 
as  food  or  remedies,  or  to  the  action  of 
drugs,  such  as  mercury,  iodine,  and  the 
mineral  acids,  which  have  been  exhibited 
for  systemic  purposes. 

The  care  of  the  mouth  of  the 
iNVALm  is  a  subject  of  great  importance 
from  both  the  hygienic  and  curative  stand- 
point. 

The  first  consideration  in  prophylaxis, 
or  prevention,  is  cleanliness.  This  applies 
with  equal  force  to  medicine,  surgery,  and 
sanitation.  It  is  the  sheet-anchor  of  suc- 
cess in  all  of  these  departments  of  science. 

The  oral  hygienist  must  therefore  base 
his  expectations  for  success  upon  cleanli- 
ness of  the  mouthy  first,  last,  and  all  the 
time. 

The  physician  insists  upon  the  daily 
bath  of  all  his  patients,  suited  of  course 
to  their  particular  case.  The  surgeon 
not  only  requires  this,  but  insists  that 
the  part  to  be  operated  upon  shall  be 

82 


THE  HUMAN  MOUTH 

rendered  surgically  clean — germ  free — 
which  is  a  much  more  exacting  proposi- 
tion than  ordinary  cleanliness.  The  den- 
tist also  requires  that  the  tooth  upon  which 
he  operates  shall  be  surgically  clean,  and 
this  he  accomplishes  by  isolating  the  tooth 
with  sterilized  rubber  dam  and  treatins: 
the  tooth  with  antiseptics. 

The  oral  hygienist  cannot,  however, 
carry  his  efforts  in  cleanliness  to  the  ex- 
treme required  by  the  surgeon  and  the 
dentist;  neither  is  it  necessary  in  order 
to  accomplish  the  success  for  which  he  is 
stri^-ing. 

The  fact  remains  that  in  the  mouth 
which  is  free  from  food  debris,  accumula- 
tions of  salivary-  calculus,  decayed  teeth, 
or  diseases  producing  suppurative  pro- 
ducts, the  fluids  of  the  mouth  have  no 
auto-infective  properties.  In  other  words, 
the  secretions  of  a  clean,  healthful  mouth 
are  physiologic  products,  although  they 
may  contain  several  species  of  mouth  or- 
ganism and  be  infective  to  another  in- 
dividual. Wounds,  even  of  an  extensive 
character,  made  in  a  clean  mouth  almost 
invariably  heal  without  inflammation  or 
other  untoward  accompaniment. 

83 


MOUTH  HYGIENE 

In  the  case  of  the  mouth  of  the  invalid 
who  has  been  accustomed,  previous  to  the 
present  illness,  to  give  proper  attention 
to  the  cleanliness  of  the  mouth  and  dental 
treatment,  there  are  no  difficulties  that 
may  not  be  overcome  with  tact  and 
patience.  In  even  the  most  desperate 
cases,  where  the  temperature  is  running 
high  and  the  mouth,  tongue  and  lips  are 
dry  and  parched,  a  gentle  cleansing  of 
the  mouth  is  most  soothing  and  grateful 
to  the  patient  and  eagerly  sought  there- 
after; and,  instead  of  being  disturbing 
and  harmful  to  the  invalid,  proves  restful, 
as  is  often  shown  by  being  followed  by 
refreshing  sleep.  It  is  not  always  pos- 
sible to  employ  the  tooth-brush  and  water 
for  cleansing  the  mouth,  as  the  patient 
may  be  too  weak  to  sit  up  or  even  to 
turn  over  on  the  side  to  eject  the  water 
from  the  mouth.  Under  these  circum- 
stances the  mouth  may  be  effectively 
cleaned  by  first  wiping  the  teeth  with 
a  piece  of  sterile  gauze,  wrapped  upon  the 
first  finger  of  the  right  hand  or  upon  an 
orange-wood  stick — the  finger  being 
preferable  for  many  reasons  which  are 
obvious — moistened   in   a  two   per   cent. 

84 


THE  HUMAN  MOUTH 

solution  of  carbolic  acid  or  a  saturated 
solution  of  boric  acid.  Then  with  the 
orange-wood  stick,  flattened  at  one  end 
and  wrapped  with  a  few  fibres  of  steril- 
ized cotton,  carefully  rub  the  surfaces  of 
all  the  teeth  w^ith  a  twenty-five  per  cent, 
solution  of  hydrogen  peroxide  (12  vol- 
ume), completing  the  cleaning  of  one 
tooth  at  a  time.  The  foam  which  is 
caused  by  the  effervescence  of  the  hydro- 
gen peroxide  in  contact  with  the  fluids  of 
the  mouth  may  be  wiped  away  with  pieces 
of  gauze  moistened  in  orange  water.  This 
cleansing  will  usually  prove  so  grateful 
and  refreshing  to  the  invalids  that  they 
will  look  forward  to  it  with  pleasureable 
anticipations. 

The  cleaning  of  the  tongue  is  a  very 
important  matter  in  all  cases  of  severe 
illness,  especially  when  the  tongue  is  con- 
stantly covered  with  a  thick,  heavy  de- 
posit— fur, — the  result  of  rapid  and  un- 
disturbed growth  of  micro-organisms. 
In  these  cases  the  tongue-scraper  will  be 
an  invaluable  aid  to  a  proper  cleaning 
of  this  organ.  The  tongue  should  be  care- 
fully wiped  afterwards  with  a  piece  of 
sterilized  gauze  moistened  with  a  satu- 
rated solution  of  boric  acid  for  its  cleans- 
ing effect. 


MOUTH  HYGIENE 

The  cleansing  of  the  tongue,  aside  from 
its  prophylactic  value,  is  a  matter  of  great 
comfort  to  a  patient  with  a  high  tempera- 
ture, and  should  never  be  neglected  when 
it  is  possible  to  accomplish  it  without  too 
much  disturbance  of  the  patient. 

On  the  other  hand,  with  a  patient  w^ho 
has  never  given  any  particular  attention 
to  the  cleanliness  of  the  mouth  or  to  den- 
tal treatment,  in  which  salivar}^  calculus 
is  present  in  considerable  amount,  den- 
tal decay  ramj^ant,  several  teeth  with  dis- 
charging abscesses,  or  suppurating  sock- 
ets from  pyorrhoea  alveolaris — Riggs's 
disease — many  difficulties  are  presented; 
difficulties  which  cannot  be  overcome  ex- 
cept by  a  dentist  or  a  dental  nurse  trained 
for  this  particular  service.  There  is  great 
need  in  all  our  hospitals  and  sanitariums 
for  nurses  of  this  character, — genteel 
young  women  who  have  received  special 
training  to  fit  them  to  take  charge  of 
general  mouth  hygiene,  to  remove  salivary 
calculus,  relieve  pain  from  exposed  pulps, 
treat  abscessed  teeth  and  other  suppura- 
tive conditions  of  the  mouth  under  the 
direction  of  the  dental  attendant. 

Except  in  very  uncleanly  and   badly 

86 


THE  HUMAN  MOUTH 

diseased  mouths,  the  nurse  will  be  able 
to  render  considerable  relief  and  give 
much  comfort  to  her  patients  by  following 
the  regime  just  laid  down. 

As  soon  as  a  patient  is  strong  enough 
to  sit  up  in  bed,  the  tooth-brush  should 
be  used,  rinsing  the  mouth  with  sterile 
water  or  a  saturated  solution  of  boric 
acid  flavored  with  orange  water  for  its 
refreshing  effects. 

It  is  never  wise  to  prolong  the  process 
of  mouth  cleansing  to  the  point  of  causing 
fatigue,  as  this  would  be  harmful.  Gen- 
tleness of  touch,  dexterity  of  manipula- 
tion, and  a  sympathetic  manner  will  soon 
allay  all  nervous  apprehensiveness  upon 
the  part  of  the  patient ;  for  it  is  a  peculiar 
fact  that  most  people  have  a  nervous 
dread  of  dental  manipulations. 

In  the  treatment  of  mouths  affected 
^\ith  rapid  dental  decay  from  the  hyper- 
acid condition  already  mentioned,  the 
deleterious  effects  of  the  acids  upon  the 
teeth  may  be  counteracted  by  the  frequent 
use  of  alkaline  or  antacid  solutions,  such 
as  bicarbonate  of  soda,  one  teaspoonful  to 
half  a  glass  of  tepid  water,  or  milk  of 
magnesia,    one   tablespoonful   to   half   a 

87 


MOUTH  HYGIENE 

glass  of  tepid  water,  or  lime  water  in  the 
same  proportions. 

Pregnant  and  nursing  women  cannot 
be  too  careful  about  their  mouth  condi- 
tions, as  their  teeth  are  prone  to  dental 
decay  during  these  periods.  The  old  say- 
ing among  midwives,  which  goes  back 
to  the  early  history  of  civilization,  "  For 
every  child  a  woman  bears  she  loses  a 
tooth,"  though  not  absolutely  true,  is 
based  upon  the  observed  fact  that  during 
pregnancy  and  lactation  dental  diseases 
are  much  more  prevalent  and  serious  than 
during  other  periods  and  that  teeth  are 
frequently  lost  during  these  periods. 
Perverted  oral  secretions,  gastric  indiges- 
tion, malnutrition,  and  faulty  metabolism 
or  disturbance  of  function  of  the  ductless 
glands  affecting  the  calcification  of  the 
bones  and  the  teeth,  are  doubtless  the 
underlying  causes. 

Many  of  these  women  suffer  from  in- 
flamed and  bleeding  gums.  This  is  in  all 
probability  due  to  plethora  of  the  upper 
part  of  the  body  induced  by  the  known 
increase  in  the  volume  of  blood  during 
pregnancy,  and  by  impeded  circulation 
resulting  from  the  pressure  of  the  gravid 
uterus  upon  the  descending  aorta. 

88 


THE  HUMAN  MOUTH 

Pregnant  women  should  protect  them- 
selves against  the  loss  of  their  teeth  by 
frequent  visits  to  the  family  dentist.  No 
woman  who  can  prevent  it  should  allow 
herself  to  approach  the  lying-in  period 
with  her  mouth  in  an  unclean  or  diseased 
condition,  as  septic  conditions  of  the 
mouth  are  exceedingly  dangerous  to  the 
lying-in  ^voman.  ^lany  accoucheurs  are 
now  so  impressed  with  this  fact  that  they 
insist  upon  their  patients  having  all  septic 
teeth  rendered  sterile  by  proper  dental 
treatment  or  extracted  before  the  lying- 
in  period,  or  refuse  to  be  held  responsible 
for  the  after  results  if  sepsis  follows 
parturition.  Many  surgeons  dislike  to 
operate,  especially  in  abdominal  cases 
or  general  non-septic  cases,  until  the 
mouth  and  teeth  have  been  carefully  in- 
spected for  septic  conditions,  and,  if  pres- 
ent, cured  or  removed. 

Only  a  few  years  ago  no  such  thought 
was  given  to  the  possible  dangers  to  the 
success  of  a  delivery  or  of  a  surgical 
operation  from  a  septic  condition  of  the 
mouth.  These  facts  are  becoming  more 
and  more  widely  recognized  by  the  pro- 
fession, and  with  corresponding  benefit 
to  suffering  humanity. 

Pregnant    and    nursing    women    fre- 


MOUTH  HYGIENE 

quently  complain  of  excessive  sensitive- 
ness of  their  teeth  to  changes  of  tempera- 
ture and  to  sweets  and  acids.  This  con- 
dition is  usually  due  either  to  an  unclean 
condition  of  the  mouth  with  acid  fermen- 
tation of  food  debris  or  to  dental  decay, 
either  superficial  or  progressive  in  its 
character.  This  may  be  overcome  by 
thorough  cleanliness  of  the  mouth,  the 
treatment  and  filling  of  the  decayed  teeth, 
and  the  use  of  bicarbonate  of  soda,  milk 
of  magnesia,  or  lime  water  as  indicated  on 
a  previous  page. 


CHAPTER  VI. 

PROPER  MASTICATION  AND  PROPER 
BREATHING. 

THE  PROPER  USE  OF  THE  TEETH  AND 
MOUTH    IN    MASTICATION. 

The  American  people  can  rightfully 
be  charged  with  two  great  sins  against 
physiologic  living:  First,  that  of  bolting 
their  food,  insufficiently  masticated  and 
inadequately  mixed  with  the  natural  se- 
cretions of  the  mouth;  second,  that  of 
drinking  large  quantities  of  iced  water 
with  their  meals.  Two  greater  handicaps 
to  a  normal  digestion  could  not  have  been 
invented,  even  by  the  evil  one  himself. 

Insufficient  mastication  and  inadequate 
insalivation  of  food  place  work  upon  the 
stomach  which  should  have  been  per- 
formed by  the  teeth  and  the  salivary 
fluids.  Drinking  iced  water  chills  the 
stomach  contents  and  retards  digestion. 
As  a  result  of  these  two  vicious  habits, 
we  are  fast  becoming  a  nation  of  dyspep- 
tics,  w^hose  minds  are  filled  with  pessimis- 
tic ideas  and  who  are  doing  much  to  sour 

91 


MOUTH  HYGIENE 

the  milk  of  human  kindness  by  om*  sombre 
views  of  life. 

No  man,  woman,  or  child  can  be  op- 
tismistic  in  their  views  of  life,  or  be  good- 
natured  and  happy  in  mind  or  physically 
full  of  life  and  energy  who  has  a  dis- 
ordered dyspeptic  stomach. 

Bolting  the  food  improperly  masticated 
is,  however,  not  always  the  result  of  the 
hurry-up  habit  which  so  afflicts  the  aver- 
age American ;  but  is  often  due  to  decayed 
and  sensitive  teeth  with  exposed  pulps, 
which  make  mastication  a  torture,  or  to 
teeth  loose  and  sore  from  abscesses  or 
from  pyorrhoea  alveolaris,  or  from  a  loss 
of  so  many  teeth  as  to  make  mastication 
impossible.  In  the  latter  case  this  de- 
ficiency can  be  corrected  by  the  insertion 
of  artificial  teeth;  while  the  former  con- 
ditions may  be  cured  or  greatly  mitigated 
and  relieved  by  appropriate  dental  treat- 
ment, and  the  adoption  of  a  suitable  hy- 
gienic regime,  such  as  the  one  already 
outlined  in  a  preceding  chapter. 

Hygienic  living,  beginning  with  a  clean 
and  healthful  mouth  and  proper  mastica- 
tion of  food,  will  soon  cure  dyspepsia  and 
banish  many  other  ills  that  are  only  reflex 

92 


PROPER  MASTICATION 

symptoms  dependent  upon  the  disordered 
stomach. 

Dr.  Gustave  Fuetterer/  in  an  article  on 
"  Round  Ulcer  of  the  Stomach  followed 
by  Carcinoma,"  says  that  this  form  of 
ulcer  located  at  the  pyloric  orifice  of  the 
stomach  becomes  carcinomatous  through 
irritation  caused  by  rubbing  or  friction 
from  particles  of  improperly  masticated 
food,  such  as  crusts  of  bread  and  hard  or 
crispy  portions  of  fried  or  baked  meats. 
Proper  mastication,  therefore,  is  a  very 
important  prophylactic  measure  against 
ulceration  and  carcinoma  of  the  stomach. 

What  is  proper  mastication?  This 
question  is  often  asked,  and  may  be 
tersely  answered  in  the  words  of  the 
"Grand  old  Man"  William  E.  Glad- 
stone, late  Prime  Minister  of  Great  Brit- 
tain.  Being  asked  to  what  he  ascribed  his 
robust  health  and  long  life,  he  replied, 
"  To  thorough  mastication  of  my  food." 
When  asked  what  he  meant  by  thorough 
mastication,  he  replied,  "Nature  has  given 
me  thirty-two  good  teeth,  so  I  aim  to  give 
every  morsel  of  food  that  enters  my  mouth 
thirty-two  bites."  A  better  answer  to  this 
question  could  not  be  found. 

*  Journal  American  Med.  Asso.,  March  15,  1902. 

d3 


MOUTH  HYGIENE 

Mr.  Fletcher,  the  American  Apostle 
of  Right  Living,  says,  "  All  food  should 
be  masticated  until  it  is  practically  lique- 
fied before  it  is  swallowed."  Such  masti- 
cation or  trituration  of  the  food  places 
it  in  the  best  possible  condition  to  be 
quickly  acted  upon  by  the  digestive  fluids 
of  the  stomach,  thus  preventing  fermen- 
tation and  the  production  of  ptomaines — 
poisonous  products  of  decomposition. 

When  food  is  swallowed  imperfectly 
masticated  and  improperly  mixed  with 
the  oral  fluids,  fermentation  is  soon  es- 
tablished, with  the  formation  of  malodor- 
ous gases,  which  cause  discomfort  or  pain, 
and  constantly  annoy  the  sufferer  by 
being  belched  from  the  mouth;  or 
ptomaines  are  formed  from  decomposi- 
tion, producing  septic  inflammation  of 
the  stomach  and  bowels,  with  diarrhoea. 
Shakespeare  says,  "  Appetite  waits  on 
good  digestion."  But  we  may  go  a  step 
further  and  say,  good  assimilation  waits 
on  good  digestion,  and  good  health  on 
good  assimilation. 

PROPER  METHOD  OF  BREATHING. 

Children  should  be  taught  early  in  life 
correct    methods    of    breathing.      Many 

94 


PROPER  BREATHING 

children  habitually  breathe  through  the 
mouth,  simply  because  they  have  not  been 
taught  to  breathe  through  the  nose,  and 
not  because  there  are  any  obstructions 
in  the  nasal  passages.  On  the  other  hand, 
many  children  are  forced  to  breathe 
through  the  mouth  because  of  narrow  or 
obstructed  nasal  passages  or  (abnormal 
growths  in  the  upper  pharynx.  When  a 
child  cannot  breathe  freely  through  the 
nose,  the  attention  of  the  physician  should 
be  immediately  called  to  this  condition  and 
proper  treatment  undertaken  at  once. 

A  child  who  habitually  breathes 
through  the  mouth  will  almost  certainly 
be  dull  mentally,  irritable  in  disposition, 
have  frequent  attacks  of  sore  throat, 
tonsillitis,  severe  colds  and  bronchitis,  and 
will  be  predisposed  to  pulmonary  dis- 
eases. 

Associated  with  abnormal  growths  in 
the  nasal  passages  there  will  be  found 
almost  invariably  a  narrow  V-shaped  or 
saddle-shaped  upper  jaw,  which  contracts 
the  nasal  passages  and  makes  nasal 
breathing  difficult,  even  without  the  ob- 
structions. If,  as  sometimes  happens,  this 
is  complicated  with  a  deviated  septum — 

95 


MOUTH  HYGIENE 

inner  division  of  the  nose — the  condition 
is  a  serious  one  and  calls  for  a  consulta- 
tion with  a  nose  and  throat  specialist  and 
a  dentist,  preferably  an  orthodontist — one 
who  regulates  the  teeth.  The  work  of 
the  nose  and  throat  specialist  will  be  to 
clear  the  nasal  passages  of  abnormal 
growths  or  conditions;  that  of  the  ortho- 
dontist will  be  to  expand  the  dental  arches 
and  bring  the  teeth  into  a  proper  align- 
ment and  normal  occlusion,  and  by  so 
doing  expand  the  nasal  passages,  thereby 
giving  the  patient  a  normal  breathing 
space. 

Children  may  be  taught  to  breathe  cor- 
rectly by  having  them  stand  erect,  with 
the  shoulders  thrown  back,  and  the  lips 
tightly  closed,  while  they  slowly  fill  the 
lungs  by  taking  in  the  air  through  the 
nose  and  as  slowly  expel  it  through  the 
same  channel.  Children  who  cannot  do 
this  after  repeated  trials  without  opening 
the  lips  will  be  found  to  have  nasal  ob- 
struction and  in  need  of  treatment. 
Breathing,  to  be  natural,  should  be  with 
the  diaphragm  and  the  abdominal  muscles. 
Raising  of  the  shoulders  while  filling  the 
lungs  under  forced  inspiration  should  be 

96 


PROPER  BREATHING 

strictly  prohibited,  as  this  develops  a 
faultlv  method  of  breathiiicr  often  seen 
in  female  singers  upon  the  stage.  Girls 
should  be  taught  that  a  tight  corset  or 
other  tight  clothing  about  the  waist  pre- 
vents normal  breathing  and  tends  to  pro- 
duce disease. 

Xature  has  provided  the  nose  with  a 
peculiar  bony  structure  kno^s^vTi  as  turbin- 
ates— bones  rolled  in  a  spiral  form — to 
increase  the  surface  of  the  air-passages 
over  which  the  air  must  pass  on  its  way 
to  the  lungs.  The  nasal  pasages,  includ- 
ing the  turbinates,  are  covered  with  a 
peculiar  ciliated  mucous  membrane,  and 
studded  with  numerous  little  glands  which 
constantly  bathe  this  membrane  with  a 
thick,  tenacious  fluid,  over  which  the  air 
must  pass  on  its  way  to  the  lungs.  Sit- 
uated just  ^vithin  the  nostrils  are  also  a 
great  number  of  tiny  hairs.  These  small 
hairs,  the  cilia — tiny  projections — and  the 
fluids  are  provided  by  nature  for  the  pur- 
pose of  purifpng  the  air  thus  passing  to 
the  lungs  of  particles  of  dust  and  other 
irritating  substances  and  many  micro-or- 
ganisms floating  in  the  atmosphere.  To 
rob  the  system  of  the  benefits  of  free 

7  d7 


MOUTH  HYGIENE 

breathing  through  normal  passages  is  to 
invite  disease,  to  handicap  our  children 
physically  and  mentally,  and  possibly  to 
lay  the  foundation  for  premature  death. 

The  introduction  of  the  out-door  school 
is  a  movement  in  the  direction  of  improv- 
ing the  health  of  the  children  so  handi- 
capped and  will  doubtless  do  much  to- 
wards lessening  the  number  of  contagious 
and  infectious  diseases ;  but  operative  pro- 
cedures will  still  be  necessary  to  relieve 
the  obstructed  nasal  passages  and  to  en- 
large these  passages  by  the  expansion 
of  the  dental  arches. 

Good  blood  can  only  be  made  from 
good  food  properly  masticated,  digested, 
assimilated,  and  oxygenated.  Proper 
mastication  cannot  be  accomplished  with- 
out good  teeth.  Normal  digestion  is  im- 
possible without  proper  mastication. 
Perfect  assimilation  is  impossible  without 
normal  digestion.  Normal  oxygenation 
is  impossible  without  free,  unobstructed, 
and  healthy  air-passages  and  plenty  of 
pure  air. 


CHAPTER  VII. 

ORAL  HYGIENE  AND  THE  SCHOOL 
CURRICULUM. 

The  principles  of  oral  hygiene  are  so 
simple  that  any  child  of  school  age,  with 
ordinary  intelligence,  can  understand 
them.  There  is,  therefore,  no  reason  upon 
that  ground  why  the  teaching  of  oral  hy- 
giene may  not  become  a  part  of  the 
curriculum  of  our  public  schools.  It 
would  not  be  necessary  to  teach  the  child 
all  the  reasons  why  bral  cleanliness  is 
essential  to  a  vigorous  body  and  mind, 
but  he  or  she  can  be  taught  how  to  keep 
the  mouth  clean,  and  some  of  the  more 
patent  and  simple,  social  and  cosmetic 
reasons  therefor,  reserving  the  more 
scientific  reasons,  such  as  belong  to  in- 
dividual health,  public  health,  increased 
mental  capacity,  longevity,  and  its  influ- 
ence upon  posterity,  to  the  higher  schools. 
No  school  curriculum,  however,  should  be 
considered  complete  that  does  not  provide 
for  the  teaching  of  this  department  of 
sanitation.  This  necessity  must  be  self- 

99 


MOUTH  HYGIENE 

evident,  from  the  facts  presented  in  the 
foregoing  pages. 

There  is,  however,  much  prejudice  to 
be  overcome,  by  those  interested  in  this 
subject,  upon  the  part  of  physicians,  pub- 
lic-health boards,  school  boards,  teachers, 
and  parents  themselves.  This  prejudice 
is  in  some  instances  due  to  a  lack  of 
knowledge  or  appreciation  of  the  fact 
of  the  very  close  relationship  which  exists 
between  an  unhealthy  and  unclean  mouth 
and  many  very  serious  general  diseases 
of  the  body,  such  as  tuberculosis,  gastri- 
tis, gastro-enteritis,  pneumonia,  diphthe- 
ria, etc.;  or  of  the  very  close  relation- 
ship which  exists  between  affections  of  the 
teeth  and  certain  diseases  of  the  eyes,  the 
ears,  the  accessory  sinuses  of  the  mouth 
and  nose,  or  of  many  reflex  neuroses  de- 
pendent upon  dental  diseases,  or  of  the 
relationship  which  epilepsy  and  insanity 
sometimes  bear  to  diseased  teeth 

In  other  instances  this  prejudice  is  the 
result  of  ultra-conservatism.  "  The  old 
way  is  good  enough."  "  Why  should  we 
take  up  every  new  fad  that  comes  along?  " 
"  Our  children  are  better  cared  for  than 
we  were,  and  yet  they  are  no  more  robust 

100 


ORAL  HYGIENE 

in  body  or  brighter  in  mind  than  was  our 
generation."      These   people    forget   the 
change   in   environment   that   has    taken 
place  since  their  school  days.     Then  the 
population    was    widely    scattered    over 
large  country  districts,  with  their  pure  air, 
wholesome  food,  early  hours,  and  simple 
pleasures  largely  enjoyed  in  the  open  air. 
Now  the  population  is  largely  crowded  into 
cities,  with  their  fetid  air,  unwholesome 
food — food  gathered  green  and  ripened 
in  transit — stale  vegetables,  cold-storage 
meats  and  eggs,  impure,  doctored  milk, 
adulterated    or    poisonous    preserved    or 
canned  fruits,  vegetables,  and  meats:  un- 
wholesome drinks  served  at  the  soda  foun- 
tains, the  syrups  made  by  synthetic  chem- 
istry instead  of  pure   fruits   and  grape 
sugar;  badly  ventilated  and  over-heated 
houses,  scho6l-rooms,  churches,  and  pub- 
lic halls;  stuffy  street-cars  and  railroad- 
coaches;    their    late    hours    and    exciting 
pleasures.    No  wonder  these  children  are 
no  more  robust  and  no  brighter  in  mind 
than  were  the  children  of  the  generation 
that  immediately  preceded  them.     The 
wonder  is  that  so  many  have  survived 
under  the  handicap  placed  upon  them. 

101 


MOUTH  HYGIENE 

Others  will  be  prejudiced  against  it 
on  account  of  the  expense  attached  to  its 
teaching  and  practice.  This  will  be  the 
objection  most  often  raised  by  the  school 
boards.  With  little  effort  it  can  be  proved 
to  the  satisfaction  of  these  gentlemen  that 
oral  hygiene  taught  and  practised  in  the 
public  schools  will  be  a  wise  economic 
measure,  as  it  improves  the  general  health 
of  the  children,  betters  their  conduct,  in- 
creases their  mental  activity  and  capa- 
city, lessens  truancy,  and  greatly  re- 
duces the  number  of  days  lost  from  ill- 
health,  as  is  shown  by  the  reports  of  Dr. 
Ebersole  and  Miss  O'Neill  (which  will 
be  found  in  Part  III,  Chapter  XV), 
while  it  greatly  reduces  the  number  of 
children  who  fail  to  pass  their  examina- 
tions and  have  to  remain  a  second  or  a 
third  year  in  the  same  grade.  Illness  im- 
poses a  heavy  drain  each  year  upon  the 
funds  of  the  school  boards  in  our  large 
cities,  and  has  been  for  many  years  one 
of  the  serious  problems  discussed  by  them. 
The  question  of  how  to  overcome  it  has 
never  been  answered  until  now.  The 
work  done  at  the  Marion  School  of  Cleve- 
land, Ohio,  has  blazed  the  way  for  the 

1102 


ORAL  HYGIENE 

anxious  school  boards,  and  has  demon- 
strated, to  those  who  are  interested  in  the 
subject  of  oral  hygiene,  that  this  depart- 
ment of  sanitation  will  prove  to  be  one 
of  the  greatest  factors  in  the  conserva- 
tion of  the  public  health;  an  equally  im- 
portant factor  in  correcting  the  ever-in- 
creasing delinquency  list  in  our  public 
schools;  adding  to  the  physical  comfort 
and  happiness  of  the  children  generally; 
improving  their  health;  clearing  their 
minds;  making  study  a  pleasure  instead 
of  a  bore,  and  improving  the  general  con- 
duct of  the  school.  Where  health  abides 
happiness  abounds.  ''  The  health  of  the 
people  is  the  supreme  law/" 

THE  TEACHING   OF  ORAL  HYGIENE  AS  A 

DEPARTME'NI'    OF    SANITARY    SCIENCE 

IN    THE    PUBLIC    SCHOOLS. 

In  most  of  the  public  schools  in  the 
poorer  districts  of  our  large  cities  it  is 
usually  the  duty  of  at  least  one  teacher 
to  inspect  the  children  as  they  enter  the 
school  building  to  see  if  their  hands  and 
faces  are  clean  and  if  the  hair  has  been 
properly  brushed  or  dressed.  Children 
who  are  not  clean  are  either  sent  home 

103 


MOUTH  HYGIENE 

or  to  the  toilet  room  to  clean  up  before 
they  are  admitted  to  the  school-room.  A 
few  lessons  of  this  character  soon  show 
their  good  effects  upon  these  careless  or 
neglected  children  and  upon  the  homes 
from  which  they  come. 

A  similar  course  might  be  pursued  in 
relation  to  the  teeth.  The  teacher  could 
ask  each  child  to  show  its  teeth  upon  pass- 
ing her,  and  if  they  were  not  clean,  the 
child's  attention  should  be  called  to  the 
fact  and  informed  that  the  teeth  should 
be  cleaned  after  every  meal.  If  the 
parents  are  too  poor  to  furnish  a  tooth- 
brush for  each  of  their  children,  then  those 
who  attend  the  school  should  be  furnished 
with  one  at  the  public  expense,  and  the 
child  taught  how  to  use  it  and  care  for  it. 

A  better  scheme  would  be  to  furnish 
every  child  in  the  school  with  a  tooth- 
brush properly  tagged  for  identification. 
The  tags  should  be  of  metal,  and  stamped 
with  the  number  of  the  room  to  which 
the  child  belongs,  his  or  her  initials,  and 
seat  number  if  the  children  are  seated  in 
this  manner.  The  brushes  of  each  room 
should  be  kept  by  themselves  in  a  special 
receptacle,  preferably  a  large  glass  jar 

104 


ORAL  HYGIENE 

with  a  ground-glass  stopper.  The  brushes 
should  be  washed  and  sterilized  by  steam, 
or  ethyl  alcohol,  after  each  use,  and  then 
immediately  placed  in  their  proper  re- 
ceptacle. By  this  plan  there  would  be 
no  danger  from  the  transmission  of  dis- 
ease from  one  mouth  to  another. 

The  objects  of  this  plan  are  two-fold: 
First,  it  makes  it  possible  to  give  the 
children  a  daily  lesson  in  how  to  clean 
their  teeth,  and,  second,  it  makes  it  pos- 
sible to  secure  at  least  one  good  cleansing 
of  the  teeth  each  school  day.  In  order 
to  carry  out  this  plan  successfully  a  tooth- 
brush  drill  must  be  organized  and  prac- 
tised every  day.  Ten  or  fifteen  minutes 
devoted  to  this  exercise  each  day  would 
be  of  great  value  to  these  children.  Ac- 
companying the  drill  should  be  a  few 
words  of  explanation  from  the  teacher 
as  to  whj^  the  teeth  and  mouth  should 
be  kept  clean, — its  advantages  to  health, 
beauty,  and  mental  activity,  also  to  its 
commercial  value  as  they  arrive  at  an  age 
when  they  are  seeking  employment.  A 
boy  or  girl,  looking  for  employment,  who 
has  a  dirty,  ill-kept  mouth  and  teeth  will 
have  a  hard  time  to  find  a  situation,  as 

105 


MOUTH  HYGIENE 

this  condition  shows  slovenly  habits  and 
most  business  men  are  afraid  to  employ 
such  people  for  fear  these  methods  might 
be  pursued  in  their  business.  A  boy  or 
girl  with  a  bright  face,  a  clean,  wholesome 
mouth  and  teeth,  and  a  pleasant  smile, 
does  not  labor  under  such  a  handicap  as 
this  and,  as  a  rule,  readily  finds  employ- 
ment. 

The  writer  believes  it  w^ould  be  a  dis- 
tinct advantage  to  public  health  if  every 
grammar  school  could  be  supplied  with  a 
trained  nurse  who  should  be  on  duty  dur- 
ing the  school  hours  to  look  after  the 
sanitary  conditions;  to  advise  with  the 
principal  and  to  take  care  of  the  children 
who  complain  of  being  ill,  to  render  first 
aid  in  case  of  accidents,  to  assist  the  medi- 
cal and  dental  school  inspectors  when 
making  their  periodical  examinations;  to 
have  charge  of  the  cleansing  and  steriliz- 
ing of  the  tooth-brushes,  and  of  the  tooth- 
brush drill. 


PART  II. 

MOUTH  SEPSIS. 


CHAPTER  VIII. 

MOUTH   SEPSIS. 

Sepsis, — putrefaction ;  infection  with 
pathogenic  micro-organisms. 

Septic, — putrid;  a  septic  substance  is 
a  putrid  substance;  that  which  produces 
or  results  from  putrefaction;  rotten. 

Sepsis,  from  the  medical  and  surgical 
stand-point,  is  the  effect  or  resultant  of 
the  decomposition  of  necrosed  or  dead 
animal  tissue,  either  in  molecular  form 
or  en  masse,  by  a  process  induced  by  the 
action  of  certain  non-pathogenic  germs — 
non-disease-producing  —  or  saprophytic 
germs,  and  the  formation  of  ptomaines — 
animal  poisons — and  their  absorption  by 
the  general  system. 

It  also  includes  infection  with  patho- 
genic— disease-producing — germs,  such  as 
the  pyogenic — pus-producing — micro-or- 
ganisms, the  Koch  or  cholera  bacillus,  the 
bacterium  typhosus — the  typhoid-fever 
germ — the  hacillus  tuberculosis — the  germ 
of  tuberculosis — and  many  others.  The 
saprophytic  germ  can  live  and  grow  only 

109 


MOUTH  HYGIENE 

in  dead  and  dying  tissues,  but  may  be- 
come the  cause  of  disease  by  indirect 
measures — the  formation  of  animal  pois- 
ons and  their  absorption — producing  what 
is  known  as  septic  poisoning.  The  'pyo- 
genic—  pus-producing —  micro-organisms 
(Figs.  XVI  and  XVII)  live  and  grow  in 
living  tissues,  destroying  the  vitality  of  the 
cellular  elements  and  converting  them  into 
pus-corpuscles.  There  are  several  varie- 
ties of  these  pyogenic  organisms,  some 
more  virulent  than  others.  The  effect  of 
infection  with  the  pyogenic  organisms  will 
always  vary  with  the  virulence  of  the  or- 
ganism, the  size  of  the  dose, — or  quantity 
introduced, — and  the  susceptibility  of  the 
tissues  infected,  in  other  words,  to  their  re- 
sistance or  the  resistive  power  of  the  gen- 
eral system. 

The  human  mouth  in  a  diseased  con- 
dition contains  many  of  the  most  virulent 
septic  micro-organisms,  especially  those 
associated  with  decayed  teeth  containing 
devitalized  or  gangrenous  tooth-pulps, — 
acute  and  chronic  dento-alveolar  ab- 
scesses, gingivitis,  stomatitis,  and  py- 
orrhoea alveolaris. 

Dr.  Hunter  William  is  of  the  opinion 

110 


Fig.  XVI. 


Forms  of  Bacteria  in  Pus  from  an  Abscess.      X  700.      .-1,  Pus-cells; 
B,  Micrococci  and  Diplococci;  C.  Streptococci;  D,  Tetracocci. 


Fig.  XVII. 


Mouth  Bacteria.     ,R.  R    Andrews.)    .1,  Diplococci  ;    B,  Leptothrix  BuccaUs. 


ORAL  SEPSIS 

that  the  most  virulent  of  all  the  pyogenic 
organisms  are  those  associated  with  ne- 
crosed bone  and  tooth  structure. 

Suppurative  or  septic  conditions  of  the 
mouth  are  exceedingly  common  and  are 
in  a  large  majority  of  cases  associated 
with  the  teeth.  The  statement  has  already 
been  made,  and  the  fact  is  recognized, 
that  dental  disorders  are  the  most  com- 
mon of  all  diseases  that  afflict  the  human 
race  and  that  many  obscure  diseases  affect- 
ing the  general  system — such  as  chronic 
dyspepsia,  gastritis,  gastro-enteritis,  cer- 
tain nervous  affections,  tonsillar  diseases, 
pharyngitis,  bronchial  and  pulmonary 
affections,  certain  diseases  of  the  eye  and 
ear,  and  general  septic  conditions  such 
as  septicaemia  and  pyemia — may  be  traced 
to  infection  from  a  septic  oral  cavity. 

A  septic  oral  cavity  is  generally,  if  not 
always,  the  result  of  neglectful  habits, 
due  usually  to  ignorance  of  the  dangers 
to  health  and  life  that  surround  such  con- 
ditions. Xeglected  dental  plates,  bridges, 
and  crowns,  faulty  fillings,  deposits  of 
food  debris,  salivary  calculus,  dental  de- 
cay,  gangrenous  dental  pulps,  acute  and 
chronic  dento-alveolar  abscesses,  pyorrhoea 
alveolaris,  gingivitis  and  stomatitis  in  their 

111 


MOUTH  HYGIENE 

various  forms,  are  all  active  factors  in 
producing  a  septic  mouth. 

Dental  surgeons  have  been  trying  for 
years  to  impress  this  fact  upon  their  pa- 
tients and  upon  the  medical  profession 
generally,  but  it  has  usually  fallen  upon 
indifferent  or  deaf  ears.  With  a  few  re- 
markable exceptions,  they  have  until  quite 
recently  made  but  few  converts  among 
medical  men.  These  gentlemen  have,  as 
a  rule,  looked  askance  at  any  opinion  upon 
a  medical  or  surgical  subject  coming 
from  a  dental  surgeon,  believing  that 
"  The  shoemaker  should  stick  to  his  last." 
This  attitude  has  doubtless  retarded  the 
just  recognition  of  oral  sepsis  as  an 
ever-present  menace  to  individual  and 
public  health.  The  subject  is  one  of 
vast  importance  from  a  public-health 
stand-point,  not  second  to  any  other  sub- 
ject that  concerns  the  physical  and  mental 
welfare  of  the  people,  for  it  strikes  at 
the  very  foundations  of  the  race  in  that 
95  per  cent,  of  all  the  public-school  chil- 
dren are  suffering  from  it,  and  as  yet  no 
adequate  measures  have  been  put  in  force 
to  cure  the  evil  or  arrest  its  progress. 

It  is  very  evident  that  the  profession, 

112 


ORAL  SEPSIS 

and  the  public  generally,  are  not  awake 
to  their  responsibility  in  this  matter,  for 
if  they  were,  the  conditions  would  soon 
be  changed.  The  introduction  of  vacci- 
nation against  small-pox  has  almost 
driven  the  disease  from  the  face  of  the 
civilized  portions  of  the  earth.  Great 
efforts  are  being  made  to  stamp  out  the 
scourge  of  tuberculosis.  Much  has  been 
done  to  prevent  cholera,  diphtheria,  teta- 
nus, rabies,  yellow  fever,  typhoid  fever, 
cerebrospinal  meningitis,  etc.,  but  practi- 
cally nothing  has  been  done  to  rescue  the 
95  per  cent,  of  the  school-children  from 
the  dangers  of  oral  sepsis. 

ORAL    SEPSIS  AND    THE    GENERAL    HEALTH. 

The  writer  first  became  interested  in 
this  subject  in  the  summer  of  1878 
through  a  very  interesting  case  referred 
to  him  by  a  lay  friend.  The  conditions 
presented  by  the  patient  were  so  grave 
and  the  results  of  the  treatment  so  satis- 
factory that  it  made  a  deep  impression 
upon  his  mind. 

The  relationship  existing  between  the 
oral  conditions  and  the  general  health 
was    not    known, — only    suspected, — but 

8  113 


MOUTH  HYGIENE 

upon  the  suspicion  that  there  was  an  in- 
timate relationship  existing  between  them, 
treatment  was  undertaken,  more,  how- 
ever, as  a  general  cosmetic  and  sanitary 
matter  than  from  any  real  expectation 
that  the  general  health  would  be  improved, 
but  with  the  hope  that  a  clean  and  healthy 
mouth  might  mitigate  some  of  the  more 
distressing  local  symptoms. 

Case  I. — History. — Miss  S.,  American, 
public-school  teacher,  aged  40,  reported, 
complaining  of  loss  of  appetite,  a  bad 
taste  in  the  mouth,  an  excessive  flow  of 
saliva,  causing  frequent  sw^allowing,  pain 
in  stomach  after  eating,  with  considerable 
flatulency,  and  a  burning  sensation  in  the 
stomach  when  empty,  nausea  in  the  morn- 
ing but  no  vomiting.  Every  afternoon 
felt  feverish,  languid,  and  tired.  Had 
frequent  attacks  of  constipation  and 
diarrhoea  and  accumulations  of  much  gas 
in  the  intestines  which  caused  discomfort 
and  embarrassment.  Had  decreased  con- 
siderably in  weight,  but  could  not  say  how 
much.  Complexion  pale  and  muddy. 
Pulse  normal,  with  no  evidences  of  fever. 
Mental  condition  not  good;  was  melan- 
cholic and  dejected;  had  lost  interest  in 

lU 


ORAL   SEPSIS 

her  work,  and  did  not  expect  to  live  very 
long. 

Mouth  in  a  very  dirty,  unsanitary  con- 
dition. Teeth  had  not  been  brushed  for 
many  weeks,  on  account  of  causing  bleed- 
ing of  the  gums.  Food  debris  covered 
all  the  teeth.  Thick  coating  of  salivary 
calculus  over  the  superior  molars  and  upon 
the  lingual  surfaces  of  the  lower  incisors, 
cuspids,  and  bicuspids;  rings  of  salivary 
calculus  at  the  margins  of  the  gums  upon 
all  the  other  teeth ;  gums  swollen,  red  and 
ulcerated  at  the  margins  and  festoons; 
pressure  upon  the  gums  caused  bloody 
pus  to  well  up  around  the  lower  anterior 
teeth  and  the  superior  molars.  Mucous 
membrane  of  the  mouth  red  and  in- 
inflamed.  Had  frequent  attacks  of  ton- 
sillitis. Teeth  showed  little  evidences  of 
dental  decay.    Xo  teeth  had  been  lost. 

Treatment. — The  treatment  consisted 
in  a  thorough  cleansing  of  the  mouth  and 
teeth  and  the  removal  of  salivary  cal- 
culus, painting  the  gums  with  the  tincture 
of  aconite  and  iodine,  equal  parts,  after 
each  treatment.  The  cleansing  of  the 
mouth  and  teeth  occupied  several  sittings 
of  an  hour  each,  extending  over  a  period 

115 


MOUTH   HYGIENE 

of  three  weeks,  with  semi-weekly  visits 
for  a  period  of  three  months,  for  treat- 
ment of  the  gums,  the  filling  of  a  few 
cavities  of  decay,  and  to  see  that  1:he 
patient  was  not  neglecting  her  instruc- 
tions as  to  mouth  cleanliness.  The  re- 
sults of  oral  cleanliness  in  this  case  ap- 
peared to  the  writer  at  the  time  as  little 
short  of  marvellous,  because  so  unex- 
pected. Her  physical  condition  began  to 
show  marked  improvement  at  the  end  of 
the  first  month.  The  bad  taste  in  the 
mouth  had  disappeared,  the  excessive  flow 
of  saliva  ceased,  the  appetite  returned, 
the  morning  nausea  was  much  lessened, 
and  the  discharges  about  the  teeth  had 
abated. 

From  this  time  on,  there  was  rapid  im- 
provement  in   all    the    other   symptoms. 
The  pain  in  the  stomach  after  eating  grad- 
ually  lessened   and   finally   disappeared, 
and  with  this  the  flatulency.     The  bowel 
symptoms,   with   the    constipation,    diar- 
rhoea, and  gas  accumulations  were  the  last 
of  the  general   symptoms  to  disappear. 
From  the  first  she  began  to  lay  on  flesh, 
her  color  became  healthful,  her  natural 
good  spirits  returned,  and  interest  in  her 

116 


ORAL   SEPSIS 

work  revived.  In  fact  she  was  a  weU 
woman  in  less  than  three  months  after  her 
mouth  and  teeth  had  been  put  in  sanitary 
condition. 

Case  II. — During  the  following  winter 
another  very  interesting  case  came  into 
my  hands  through  the  courtesy  of  a  medi- 
cal friend. 

History, — Mrs.  R.  S., — Hebrew,  aged 
oO  years,  very  pale  and  anemic.     Com- 
plained of  loss  of  appetite,  a  very  sore 
and  sensitive  mouth,  tonsils  and  phar^Tix 
very  red  and  inflamed,  and  had  constant 
hacking   cough;    sahva    thick   and   ropy; 
could     not     sleep     when     lying     down; 
was  exceedingly  nervous,  irritable  in  dis- 
position,  and   greatly   depressed.      Had 
one  tooth  that  had  given  great  trouble — the 
upper  left  cuspid — face  had   frequently 
been  swollen  and  pus  discharged  into  the 
mouth.     The  physician  had  sent  her  to 
the  writer  for  the  extraction  of  this  tooth. 
Examination  of  the  mouth  revealed  the 
most  astounding  oral  condition  that  had 
ever  come  under  the  notice  of  the  ^\Titer 
up  to  that  time.     The  troublesome  tooth 
was    the   least    grave    of    the    conditions 
found  to  exist. 

117 


MOUTH   HYGIENE 

The  patient  had  in  her  mouth  a  partial 
denture  made  on  a  silver  base,  that  only 
partially  covered  the  roof  of  the  mouth, 
and  containing  eight  teeth,  to  replace  the 
superior  right  and  left  lateral  incisors  and 
the  right  and  left  first  and  second  bicus- 
pids and  first  molars,  and  held  in  position 
by  clasps  fitted  to  the  cuspid  and  second 
molar  teeth.  Before  attempting  an  ex- 
amination preparatory  to  removing  the 
tooth,  the  patient  was  requested  to  take 
out  her  plate.  She  said  she  could  not, 
that  it  was  put  in  by  her  New  York 
dentist  fifteen  years  ago,  and  that  it  had 
never  been  out  of  her  mouth  since;  that 
it  had  grown  (?)  fast  and  that  it  was  im- 
possible to  remove  it.  Examination  of 
her  mouth  revealed  the  fact  that  it  was 
impossible  for  her  to  remove  the  plate, 
for  it  was  firmly  cemented  in  position  by 
accumulations  of  salivary  calculus,  which 
covered  the  teeth  on  each  side  from  and 
including  the  third  molars,  forward  to  the 
first  bicuspids  attached  to  the  silver  plate. 
The  mouth  was  in  a  very  unclean  state, 
the  lower  teeth  in  a  filthy  condition  from 
the  remains  of  food  debris.  The  gums  and 
the    roof   of   the    mouth   were    red   and 

118 


ORAL   SEPSIS 

swollen,  and  the  plate  embedded  in  the 
mucous  membrane  of  the  roof  of  the 
mouth.  The  plate  was  oxidized  upon  the 
exposed  surface  to  a  jet-black  color. 
Pressure  on  the  plate  caused  pain  beneath 
it.  Evidently  the  irritation  from  the  em- 
bedded plate  was  very  considerable. 

The  writer's  experience  with  Case  I 
led  him  to  suggest  to  the  patient  that  her 
ill  health  and  nervous  condition  was  due 
largely,  if  not  altogether,  to  the  diseased 
condition  of  her  mouth,  and  that  nothing 
could  be  done  in  the  way  of  treatment 
until  the  plate  was  removed  and  the  mouth 
and  teeth  thoroughly  cleansed.  Upon 
consultation  with  her  physician,  the  case 
was  placed  in  the  writer's  hands  for  such 
treatment  as  he  might  think  best,  as  she 
had  been  under  his  care  off  and  on  for 
several  years  with  only  temporary  benefit. 

An  appointment  was  made  for  the  next 
day,  when,  after  an  hour  of  tedious  and 
painstaking  labor  with  chisels  and  excava- 
tors, the  calculus  was  cut  away  and  the 
plate  removed. 

The  under  surface — that  in  contact  with 
the  roof  of  the  mouth — of  the  plate  was 
not  discolored,  in  fact  it  looked  as  if  it 

119 


MOUTH   HYGIENE 

had  just  come  out  of  the  acid-bath,  all 
other  portions  were  jet  black,  showing 
oxidation.  The  soft  tissue  upon  which 
the  plate  rested  was  covered  with  coarse 
granulations,  which  gave  an  acid  reaction 
to  litmus  paper.  There  was  considerable 
recession  of  the  gums  around  all  the  teeth 
with  which  the  plate  was  in  contact,  and 
all  were  more  or  less  loose  and  discharg- 
ing a  greenish  pus. 

The  mouth  was  then  carefully  washed 
with  a  solution  of  phenol  sodique,  one 
teaspoonful  to  a  glass  of  water,  and  the 
troublesome  tooth  extracted;  the  patient 
dismissed  ^vith  instructions  to  rinse  the 
mouth  with  a  similar  weak  solution  of 
phenol  sodique  every  two  hours  during 
the  day  and  to  return  for  further  treat- 
ment in  two  days.  At  the  next  sitting 
she  reported  herself  as  much  more  com- 
fortable ;  the  mouth  less  sore  and  the  saliva 
less  ropy;  did  not  cough  so  much  last 
night.  This  was  encouraging;  so  pro- 
ceeded to  remove  the  salivary  deposits 
from  the  lower  teeth.  The  roof  of  the 
mouth  was  still  very  tender  and  sensitive. 
Recommended  liquid  diet  for  a  few  days, 
or  until  the  mouth  had  healed,  and  fre- 

120 


ORAL   SEPSIS 

quent  rinsing  of  the  mouth  and  gargling 
of  the  throat  with  the  phenol  sodique 
solution.  Instructed  to  report  every 
second  day. 

At  the  third  visit  the  surfaces  of  all 
the  teeth  were  examined  for  unremoved 
deposits  and  carefully  polished.  The 
mouth  conditions  have  greatly  improved; 
roof  of  the  mouth  healing  rapidly,  ropy 
condition  of  the  saliva  is  much  less,  cough 
greatly  improved,  tonsils  and  pharynx 
less  inflamed,  can  lie  dow^n  and  sleep  with 
little  disturbance  from  the  cough;  has  a 
little  appetite.  Recommended  that  she 
take  soft  food — soft-boiled  eggs,  milk 
toast,  mashed  vegetables,  etc. 

Fourth  visit.  JNIouth  has  healed,  and 
the  taking  of  food  is  no  longer  painful; 
ropy  condition  of  the  saliva  has  entirely 
disappeared;  seems  to  be  normal;  sleeps 
w^ell ;  cough  is  much  better ;  appetite  good. 
Recommended  full  diet.  Says  she  feels 
better  than  she  has  for  months.  Gave  her 
specific  instructions  as  to  the  care  of  the 
mouth,  and  further  explained  the  neces- 
sity of  great  diligence  upon  her  part  to 
keep  the  mouth  free  from  all  foreign 
substances  that  could  in  any  way  cause  ir- 

121 


MOUTH   HYGIENE 

ritation  and  inflammation  of  the  tissues. 

The  case  steadily  improved  day  by  day, 
and  at  the  end  of  three  months  was  dis- 
charged cured,  greatly  to  her  delight  and 
that  of  her  friends  and  her  physician. 

Many  more  or  less  similar  cases  from 
the  early  experience  of  the  writer  could  be 
introduced  to  prove  the  unhealthy  and 
dangerous  effects  of  a  septic  mouth,  but 
these  are  sufficient  for  the  present  pur- 
pose. The  writer  is  free  to  admit,  how- 
ever, that  at  this  period  in  his  professional 
life,  he  was  groping  in  the  dark  for  some 
real,  tangible,  scientific  explanation  of 
how  a  dirty,  unsanitary  mouth  could  pro- 
duce such  grave  general  symptoms,  and, 
although  he  was  familiar  with  the  "  germ 
theory  "  of  disease,  it  was  not  until  the 
publication  of  Sir  Joseph  Lister's  ideas 
of  sepsis  and  antisepsis  in  relation  to 
surgical  wounds  and  diseases,  that  he  be- 
gan to  appreciate  the  relationship  that 
might  exist  between  them.  But  a  full 
realization  of  this  relationship  was  not  ob- 
tained until  the  publication  of  Prof.  W. 
D.  Miller's  work  on  "  The  Micro-organ- 
isms of  the  Human  Mouth  and  the  Local 
and  General  Diseases  which  are  Caused  by 

122 


ORAL   SEPSIS 

them."  To  this  work  of  Prof.  Miller  the 
profession  and  the  world  owe  much, 
very  much,  for  he  not  only  searched 
out  and  published  to  the  world  the 
local  causes  which  produce  decay  of  the 
teeth,  but  also  proved  that  an  unsani- 
tary mouth  is  the  habitat  of  numerous 
pathogenic  bacteria  which  grow  and 
multiply  at  a  tremendous  rate  and  are  a 
source  of  constant  infection  and  reinfec- 
tion of  other  organs  and  tissues  of  the 
body,  and  constitute  through  their  ever- 
constant  presence  one  of  the  greatest 
dangers  to  the  health  of  which  sanitary 
and  medical  science  has  any  knowledge. 
In  the  light  of  our  present  knowledge 
in  relation  to  sepsis  and  the  spread  of 
disease  by  infection,  the  etiology  of  the 
two  cases  just  referred  to  is  readily  under- 
stood. In  both  cases  the  origin  of  the  dis- 
eased condition  was  the  unhygienic  and 
unsanitary  condition  of  the  mouth  and 
teeth:  in  the  first,  resulting  in  a  septic 
gastro-enteritis ;  and  in  the  latter,  septic 
inflammation  of  the  fauces,  an  irritative 
cough  due  to  this  inflammatory  condition, 
and  the  thick  ropy  saliva  and  a  general 
neurasthenic  condition  from  the  constant 

123 


MOUTH   HYGIENE 

irritation  of  the  artificial  denture  and  sep- 
tic intoxication. 

To  Dr.  William  Hunter,  of  London 
Fever  Hospital,  belongs  the  credit  of 
arousing  the  profession  to  a  realizing 
sense  of  the  great  dangers  to  the  individ- 
ual and  public  health  from  oral  sepsis  by 
the  publication  (in  the  (London)  Practi- 
tioner for  December,  1900)  of  his  re- 
searches and  personal  experiences  upon 
this  subject.  In  his  introduction  he  says: 
"For  the  last  twelve  years,  in  connection 
with  various  studies,  my  attention  has  been 
called  in  increasing  degree  to  an  important 
and  prevalent  source  of  disease,  one  whose 
importance,  I  think,  is  not  sufficiently  rec- 
ognized. The  source  is  oral  sepsis — sepsis 
arising  in  connection  with  diseased  condi- 
tions of  the  mouth.  ]\Iy  attention  was 
first  draw^n  to  it  in  connection  with  the 
patholog}^  of  ansemia;  and  since  then  it 
has  been  extended  in  connection  with  the 
patholog}^  of  a  great  number  of  infective 
diseases  which  have  one  factor  in  com- 
mon— namely,  septic  organisms  under- 
hung them. 

"  The  case  which  brought  to  a  head  my 
interest  in  this  subject  was  one  I  met  with 

in 


ORAL   SEPSIS 

some  two  years  ago.  It  definitely  proved 
the  connection  between  oral  sepsis  and 
one  of  its  commonest  eiFects — one  so 
marked  and  so  common  that  I  have  desig- 
nated it  by  a  special  name,  septic  gastritis. 
Since  then  I  have  seen  a  large  number 
of  cases,  illustrating  both  the  frequency 
and  the  importance  of  the  subject;  illus- 
trating, moreover,  what  I  regard  as  more 
striking — the  extraordinary  degree  to 
which  oral  sepsis  is  overlooked,  alike  by 
all  parties  concerned — the  physician,  the 
surgeon,  the  patient. 

"  I  have  already  had  occasion  to  draw 
attention  to  the  subject;  but  additional 
experience  only  serves  more  and  more 
to  emphasize  its  importance  from  medical, 
surgical,  and  preventive  medicine  points 
of  view. 

"  I  desire  here  to  point  out  once  more 
how  common  a  cause  of  disease  it  is,  how 
grave  are  its  effects,  how  constantly  it  is 
overlooked,  and  what  remarkable  bene- 
ficial results  can  be  gotten  from  its  re- 
moval. In  so  doing  it  is  not  my  purpose  to 
select  rare,  isolated  cases  from  the  litera- 
ture in  order  to  produce  a  picture  which 
may  arrest  attention  from  its  dark  colors. 

125 


MOUTH  HYGIENE 

I  shall  illustrate  the  subject  by  cases  from 
my  own  experience,  thereby  bringing  out 
how  common  the  condition  is."  The  in- 
terested reader  is  referred  to  this  article. 
Durino'  the  last  decade  much  interest 
has  been  manifested  in  this  subiect  by 
certain  members  of  the  profession,  and 
much  interesting  material  has  been  added 
to  the  literature  of  the  subject,  particu- 
larly in  relation  to  its  prevalence  and  a 
more  general  recognition  of  its  potency 
as  a  factor  in  spreading  infectious  diseases. 
And  vet  there  are  many,  verv  many, 
professional  people  who  do  not  realize  the 
importance  of  controlling  or  eradicating 
from  our  midst  the  great  evil  of  an  un- 
hygienic, imsanitary,  septic  mouth.  The 
condition  is  so  common,  even  among  other- 
wise cleanly  persons,  that  it  is  overlooked, 
or,  through  colossal  ignorance  of  its 
dangers  to  the  health  of  the  individual 
and  the  public,  thought  to  be  not  worth 
serious  consideration.  The  interdiction 
by  law  of  spitting  in  any  street-cars,  rail- 
road coach,  halls  of  public  assembly,  and 
upon  the  side-walks  vriW  do  much  to  pre- 
vent the  spread  of  infectious  diseases. 
But  this  is  a  measure  aimed  primarily 

126 


ORAL   SEPSIS 

at  the  prevention  of  the  spread  of  tubercu- 
losis, and  did  not  at  the  time  take  into 
account  the  dangers  of  the  dissemination 
of  various  diseases  by  the  organisms 
found  in  a  septic  oral  cavity;  and  yet  some 
of  the  pathogenic  organisms  found  in  the 
mouth  are  nearly  as  virulent  as  is  the 
tubercule  bacillus. 

The  spread  of  such  infectious  diseases 
as  diphtheria,  tonsillitis,  pharyngitis,  in- 
fluenza, bronchitis,  pneumonia,  and  pul- 
monary tuberculosis  among  the  children 
of  the  public  schools  is,  without  doubt, 
greatly  augmented  by  the  usual  unsani- 
tary condition  of  the  mouths  of  a  great 
majority  of  the  children. 

The  fight  that  is  being  made  against 
the  spread  of  tuberculosis  meets  with 
many  physical  barriers  that  are  difficult 
to  overcome.  Xot  so  with  oral  sepsis; 
the  only  obstacles  in  the  way  of  a  com- 
plete revolution  in  this  matter  are  indiffer- 
ence, prejudice,  and  ignorance. 


127 


CHAPTER  IX. 

DISEASES  OF  THE  TEETH  AND  MOUTH 
CAUSED  BY  ORAL  SEPSIS. 

The  toxic  nature  or  poisonous  prop- 
erty of  human  saliva  is  a  well-known  fact, 
the  knowledge  of  which  dates  back  to  the 
earliest  days  of  medicine. 

Galen,  Aristotle,  Pliny,  and  other  an- 
cient writers  speak  of  its  poisonous  effects 
upon  animals.  Aristotle  mentions  a  girl 
whose  bite  was  as  poisonous  as  that  of 
a  venomous  snake,  and  that  animals 
wounded  with  arrows  dipped  in  her  saliva 
died  from  its  effects.  There  is  also  a 
popular  impression  that  the  human  saliva 
is  most  virulent  or  poisonous  during  anger 
or  nervous  excitement. 

Pasteur  (1881)  discovered  the  poison- 
ous nature  of  human  saliva  to  depend 
upon  a  group  of  mouth  micro-organisms, 
including  the  micrococcus  of  sputum 
septicsemia.  Miller  looks  upon  this 
organism  as  one  of  the  most  important 
of  all  the  mouth  bacteria,  as  it  is  very 
virulent  and  is  the  same  organism  that 

12S 


TEETH   AND   MOUTH 

produces  lobar  pneumonia — the  pneumo- 
coccus — and  doubtless  the  direct  cause  of 
this  disease.  Injections  of  cultures  of  this 
organism  killed  rabbits  in  from  twenty- 
four  to  thirty-six  hours.  The  bacteria 
of  the  human  mouth  are  very  numerous, 
as  shown  by  the  investigations  of  Miller, 
Black,  Robin,  .Goadby,  Vicentini,  and 
other  investigators.  Considerably  over  a 
hundred  different  species  have  been  dis- 
covered at  various  times  and  under  vary- 
ing conditions.  About  one-third  of  these 
are  known  to  be  pathogenic — disease-pro- 
ducing— germs,  some  of  which  have  prop- 
erties of  great  virulence,  for  instance,  the 
micrococcus  of  sputum  septicgemia  just 
referred  to  and  the  bacillus  pulpse  gangre- 
nos£e — the  organism  found  in  a  decompos- 
ing tooth-pulp — which  is  the  most  virulent 
of  all  and  is  the  common  cause  of  acute 
dento-alveolar  abscess. 

The  pyogenic — pus-producing — organ- 
isms are  found  everywhere:  in  the  air,  in 
water,  in  the  soil,  in  the  dust  of  the  streets ; 
upon  the  surfaces  of  the  human  body,  par- 
ticularly in  the  epidermal  covering  of  the 
skin,  in  the  folds  of  the  skin,  at  locations 
where  the  sweat  glands  are  most  numer- 

9  129 


MOUTH   HYGIENE 

ous — under  the  arm,  etc.;  in  the  hair, 
under  the  finger  nails,  in  the  nasal  pas- 
sages ;  but  most  abundantly  in  the  mouth. 

It  is  generally  conceded  that  these  or- 
ganisms are  found  in  every  mouth,  the 
abundance  being  governed  largely  by  its 
hygienic  and  sanitary  condition.  The  un- 
sanitary mouth  offers  a  most  admirable 
field  and  soil  in  which  they  grow  and 
multiply  with  great  rapidity. 

These  organisms  are  really  omnipres- 
ent, and  ready  at  all  times  to  take  ad- 
vantage of  any  opportunity  offered  to 
attack  the  tissues  of  the  body  and  produce 
disease. 

AVENUES  OF  INFECTION  OF  MOUTH 
BACTERIA. 

Prof.  Miller  arranges  these  avenues 
of  infection  under  six  heads,  according  to 
the  point  of  entrance: 

"  1st.  Infections  caused  by  a  break  in 
the  continuity  of  the  mucous  membrane, 
brought  about  by  mechanical  injuries. 
These  lead  to  either  local  or  general  dis- 
turbances. 

"  2d.  Infections  through  the  medium  of 
gangrenous  tooth-pulps,  which  lead  to  the 

130 


TEETH  AND   MOUTH 

formation  of  abscesses  at  the  point  of  in- 
fection, but  may  also  lead  to  secondary 
septicaemia  and  pysemia  with  fatal  ter- 
mination. 

"  3d.  Disturbances  conditioned  by  the 
resorption  of  poisonous  waste  products 
formed  by  bacteria. 

"  4th.  Pulmonary  diseases  caused  by 
inspiration  of  slime — ^mucus — small  pieces 
of  tartar,  etc.,  containing  bacteria. 

"  5th.  Excessive  fermentative  pro- 
cesses, and  other  complaints  of  the  diges- 
tive tract,  caused  by  the  continual 
swallowing  of  microbes  and  their  poison- 
ous products. 

"  6th.  Infections  of  the  intact  soft 
tissues  of  the  oral  and  pharyngeal  cavities 
whose  power  of  resistance  has  been  im- 
paired by  debilitating  diseases,  mechanical 
irritations,  etc. 

"  In  this  connection  the  possibility  of 
an  infection  by  the  accumulation  of  the 
excitants  of  diphtheria,  typhus,  syphilis, 
etc.,  in  the  mouth  must  also  be  taken  into 
consideration." 

The  most  common  avenue  of  infection 
by  pyogenic  bacteria  within  the  mouth  is 
through  some  break  in  the  continuity  of 

131 


MOUTH  HYGIENE 

the  mucous  membrane.  It  may  be  only 
a  slight  abrasion  or  a  minute  wound  such 
as  might  be  made  by  the  bristles  of  a 
hard  tooth-brush,  a  tooth-pick,  a  fish-bone, 
or  a  too  vigorous  use  of  the  floss-silk,  or 
a  more  serious  lesion  such  as  that  made 
by  the  extraction  of  a  troublesome  tooth, 
either  of  which  would  furnish  a  sufficient 
entrance  or  point  of  attack,  and  might 
prove  exceedingly  dangerous  in  a  particu- 
larly unclean  mouth,  by  reason  of  a  low- 
ered vital  resistance  of  the  injured  tissues 
or  of  the  general  system  such  as  might 
follow  a  debilitating  illness. 

That  the  presence  of  pathogenic 
bacteria  in  the  mouth  does  not  always  re- 
sult in  the  production  of  disease  is  due 
in  large  measure  to  the  remarkable  resist- 
ive powers  possessed  by  the  mucosa  of 
the  mouth,  to  the  power  of  the  blood, 
through  the  phagocytes — white  cells — to 
destroy  the  bacteria  that  may  enter  the 
system,  and  to  the  number  that  may  gain 
an  entrance  or  be  introduced  at  any  one 
time.  This  process  may  be  looked  upon 
as  a  desperate  battle  waged  between  two 
opposing  armies;  the  phagocytes  upon 
the  one  side,  and  the  bacteria  on  the  other, 

132 


TEETH  AND   MOUTH 

being  assured  that  the  strongest  and  most 
numerous  force  will  conquer.  How  im- 
portant, then,  is  the  conservation  of  the 
general  health! 

DISEASES  OF  THE  TEETH. 

The  most  common  disease  of  the  teeth, 
due  to  an  unsanitary  mouth,  is  that  of 
dental  decay,  as  already  stated  in  a  pre- 
vious chapter,  and  is  due  to  the  dissolving 
action  of  acids  upon  the  hme  salts  of  the 
teeth.  These  acids  are  produced  by  the 
action  of  the  zymogenic — fermentative — 
bacteria  upon  particles  of  food  left  in  the 
mouth  and  lodged  between  the  teeth  or  in 
the  pits  and  grooves  upon  their  surfaces. 
This  action  always  begins  upon  the  outer 
surface,  or  enamel,  of  the  teeth,  and  as 
the  enamel  becomes  softened  it  is  re- 
moved by  the  friction  of  mastication  and 
other  means,  leaving  a  shallow  cavity, 
which  then  offers  a  larger  and  more  suit- 
able lodging-place  for  food  and  greater 
activity  of  the  acid-producing  germs. 
This  process  of  decay  usually  extends 
towards  the  centre  of  the  tooth,  follow- 
ing the  dental  tuhuli — microscopic  tubes 
in  the  dentine.    The  acid-producing  germs 

133 


MOUTH  HYGIENE 

penetrate  the  dental  tubuli  and  rapidly 
multiply,  and  by  dissolving  the  lime  salts 
of  the  surrounding  dentine,  enlarge  the 
tubuh  (Fig.  XVIII).  Later  these  en- 
larged tubuli  coalesce  to  form  cavities 
which  are  filled  with  the  germs  (Fig. 
XIX).  This  process  goes  on  until  the 
dental  pulp  is  reached.  The  acid  formed 
by  the  fermentation  of  the  food  debris  acts 
more  rapidly  upon  the  dentine  than  upon 
the  enamel,  and,  as  the  process  of  decalci- 
fication— removing  of  the  lime  salts — goes 
on,  the  dental  tubuli  are  left  behind  as  the 
leathery  or  cartilaginous  substance,  which 
is  later  gradually  dissolved  or  liquefied 
by  the  saprophytic — putrefactive — ^germs 
and  washed  away.  The  disagreeable  odor 
and  taste  from  a  decaying  tooth  are 
caused  by  the  putrefaction  of  this  cartilag- 
inous substance.  This  process  of  decay 
may  become  arrested  through  a  changed 
environment,  which  constitutes  immunity. 
Just  what  constitutes  this  change  in  en- 
vironment has  not  as  yet  been  positively 
proved,  but  that  it  is  related  to  the  salivary 
secretions  there  seems  little  reason  to 
doubt,  as  shown  by  an  article  recently 
published  in  the  American  Journal  of 

134 


Fig.  XVIII. 


r 


I     ' 


i 


U. 


i 


1>. 

I 


Infected    Dentine,   .Showing    Tubuli   Greatly    Emarged    and    Filled    with 

Micro-organisms. 


Fig.  XIX. 


Infected   Dentine,    Showing   Coalescence  of  Enlarged  Tubuli  forming   Cavi- 
ties and  Filled  with  Micro-organisms.     (R.R.Andrews.) 


TEETH  AND  MOUTH 

Physiology,  upon  the  results  of  extensive 
research  upon  the  Neutralizing  power  of 
the  Saliva  in  its  relation  to  Dental  caries/ 

PULPITIS. 

One  of  the  common  results  of  dental 
decay  is  pulpitis — inflammation  of  the 
tooth-pulp — or  tooth  che  produced  by  the 
pyogenic  bacteria.  This  is  an  exceedingly 
pamful  affection,  which  sooner  or  later 
ends  in  death  of  the  organ  and  remission  of 
pain.  Children  frequently  suffer  from  this 
form  of  dental  disease  when  their  teeth 
are  neglected  and  allowed  to  decay. 

Dento-alveolar  A  bscess  —  gum-boil  — 
usually  follows  death  of  the  pulp  after  an 
interval  of  from  two  to  four  weeks,  by 
infection  of  the  tissues  at  the  apex  of  the 
root  with  the  virulent  bacillus  pulpce  gan- 
grenosce.  These  organisms  follow  the 
canal  in  the  root  and  set  up  most  violent 
acute  inflammation,  and  the  formation  of 
an  abscess,  accompanied  by  severe  throb- 
bing pain,  great  swelling,  and  elevation  of 
temperature.  This  is  a  serious  affection 
and  should  never  be  neglected,  as  it  may 
result  in  necrosis  of  the  jaw  or  acute  sep- 

*  Marshall,  John  Albert,  M.S.:  The  American  Journal 
of  Physiology,  vol.  xxxvi.  No.  3,  Feb.,  1915,  pp.  260-279. 

135 


MOUTH  HYGIENE 

ticsemia  —  blood-poisoning  —  and  death. 
Many  cases  are  on  record  of  a  fatal  ter- 
mination of  this  disease.  The  abscess  if 
allowed  to  run  its  course  will  usually,  ex- 
cept in  the  very  serious  cases,  point  upon 
the  gum  and  rupture — break — discharg- 
ing its  contents  into  the  mouth,  when  the 
more  acute  symptoms  will  subside,  but 
leaving  behind  a  chronic  discharge  which 
may  last  for  years  unless  appropriate 
treatment  is  adopted.  This  latter  condi- 
tion constitutes  one  of  the  most  prolific 
sources  of  oral  sepsis. 

Dento-alveolar  abscesses  associated  with 
the  upper  jaw  not  infrequently  rupture 
into  the  nasal  fossa,  simulating  a  chronic 
nasal  catarrh,  or  into  the  maxillary  sinus 
— a  natural  cavity  in  the  upper  jaw  just 
above  the  bicuspid  and  molar  teeth  and 
beneath  the  eve — and  cause  what  is  known 
as  empyema — a  collection  of  fluid — gen- 
erally pus  from  the  abscess  which  has 
discharged  into  it.  After  a  time  gas  is 
formed  in  the  sinus  from  putrefaction  of 
the  pent-up  fluid  causing  distention  and 
pain  with  protrusion  of  the  eyeball  upon 
the  affected  side.  The  walls  of  the  sinus 
become  thinned  and  sooner  or  later  rup- 

136 


TEETH  AND  MOUTH 

ture.  This  usually  occurs  into  the  nose, 
as  the  bone  at  this  point  is  least  resistant. 
Occasionally  it  will  rupture  into  the  orbit 
and  penetrate  the  skull,  causing  death  by 
septic  cerebral  meningitis. 

Dento-alveolar  abscess  associated  's^ath 
the  lower  jaw  usually  ruptures  upon  the 
gum  within  the  mouth,  but  it  is  by  no  means 
uncommon  for  it  to  penetrate  the  soft 
tissues  of  the  face  and  discharge  upon 
the  chin  or  lower  border  of  the  jaw. 
Not  infrequently  the  abscess  will  pene- 
trate the  lingual  alveolar  plate  and  bur- 
row into  the  soft  tissues  of  the  floor  of 
the  mouth  and  produce  a  septic  cellulitis 
or  Ludwig's  angina.  Occasionally,  as  in 
the  case  of  impacted  lower  third  molars, 
the  pus  will  burrow  beneath  the  jaw  and 
follow  the  spaces  between  the  muscles  and 
rupture  upon  the  neck  or  breast.  The  lat- 
ter are  very  serious  conditions  and  may 
terminate  fatally  through  general  septic 
poisoning.  The  common  results  of  violent 
acut€  dento-alveolar  abscess  are  periostitis, 
ostitis,  osteo-myelitis,  abscess  of  the  acces- 
sory sinuses,  and  necrosis,  or  death  of  the 
bone.  These  conditions  are  productive  of 
very    grave    results,    as    they    furnish, 

137 


MOUTH  HYGIENE 

through  the  constant  discharge  of  a  very 
virulent  pus,  one  of  the  most  serious 
sources  of  auto-infection,  both  local  and 
general,  that  are  to  be  found  in  the  oral 
cavity. 

The  absorption  of  ptomaines  and  the 
entrance  of  the  micro-organisms  into  the 
blood  and  lymph  channels  from  dento- 
alveolar  abscess,  periostitis,  osteitis,  osteo- 
myelitis, and  necrosis  of  bone  are  also 
productive  of  many  serious  affections  in 
remote  parts  of  the  body  dependent  upon 
pyogenic  infections  and  saprophytic  or 
septic  intoxication. 

The  soft  tissues  of  a  septic  oral  cavity 
are  very  prone  to  take  on  inflammatory 
action,  particularly  if  the  teeth  are  badly 
decayed  and  salivary  deposits  are  present 
in  considerable  amount,  as  these  condi- 
tions produce  more  or  less  mechanical  irri- 
tation, abrasions,  and  slight  wounds  upon 
the  mucous  surfaces.  Such  wounds  per- 
mit the  entrance  of  the  pyogenic  bacteria 
and  set  up  septic  inflammation  and  ulcera- 
tion. The  gums  are  very  liable  to  these 
forms  of  inflammation,  through  the  me- 
chanical irritation  and  abrasion  of  the  tar- 
tar found  upon  the  teeth  and  encroaching 

138 


TEETH  AND  MOUTH 

upon  the  gums.  The  mucous  coverings 
of  the  lips  and  cheeks  are  often  injured  by 
the  same  cause  and  by  rough  and  jagged 
portions  of  decaying  teeth,  and  also  by 
infection  of  glandular  structures  from 
the  presence  of  the  pyogenic  bacteria. 
The  tongue  is  sometimes  the  seat  of  ulcers 
due  to  the  mechanical  irritation  of  decayed 
teeth  and  masses  of  tartar,  and  infection 
with  the  pyogenic  bacteria,  and  which  do 
not  heal  until  these  causes  of  irritation 
are  removed.  Ulcers  of  this  character 
ing-points  of  cancer.  The  local  manifes- 
tations of  pyorrhoea  alveolaris — namely, 
the  suppurative  conditions  of  the  sockets 
of  the  teeth — are  due  to  infection  from 
the  same  pyogenic  bacteria,  and  unless 
these  conditions  are  successfully  com- 
bated will  lead  sooner  or  later  to  loss  of 
the  teeth.  Dr.  Woods  Hutchinson  re- 
cently said  in  discussing  the  value  of  the 
teeth — good  teeth — to  the  general  health: 
"  JNIan  hangs  onto  hfe  by  his  teeth.  When 
we  talk  about  losing  our  grip  it  is  often 
our  dental  grip  that  we  mean."  "  Their 
importance  is  only  equaled  by  their  promi- 
nence and  accessibility.    They  are  first  in 

130 


MOUTH  HYGIENE 

peace,  first  in  war  and  first  in  the  mouths 
of  our  countrymen,  and  whenever  we  will 
we  can  do  them  good."  "The  next  demand 
of  the  teeth  is  that  they  be  kept  clean,  and 
for  that  purpose  nothing  has  been  invented 
to  equal  the  modern  tooth-brush."  "  The 
proof  of  the  brushing  is  in  the  shiny  teeth, 
and  upon  a  basis  of  hundreds  of  thousands 
of  cases,  there  is  nothing  that  either  the 
medical  or  dental  professions  feels  so  abso- 
lutely confident  of  getting  desired  results 
from  as  from  plain  bristles  faithfully  ap- 
plied three  times  a  day."  "Brush  without 
ceasing,  thoroughly,  gums  as  well  as  teeth, 
after  every  meal  and  at  bedtime,  and  you 
can  pretty  certainly  bank  upon  it  that 
your  teeth  will  stay  by  you  until  sixty, 
sixty-five  ©r  seventy.  You  will  probably 
lose  a  few  even  with  the  best  of  care,  but 
you  will  have  plenty  left  to  anchor  to, 
your  dental  arches  may  be  *  disfigured,  but 
still  in  the  ring,'  until  you  yourself  throw 
up  the  sponge." 


140 


CHAPTER  X. 

DISEASES  OF  THE  THROAT,  THE  EAR,  THE 

EYE,  AND  THE  CERVICAL  GLANDS 

CAUSED  BY  ORAL  SEPSIS. 

Throat  affections  are  always  more 
prevalent  during  the  winter  or  cold 
months  and  early  spring  than  during  the 
summer.  The  popular  opinion  as  to  the 
reason  for  this  difference  in  the  seasonal 
prevalence  is  that  during  the  cold  months 
and  early  spring  people  are  more  liable 
to  take  cold  than  they  are  in  the  summer 
months. 

The  correct  explanation,  in  the  writer's 
opinion,  lies  in  the  fact  that  during  the 
summer  time  the  people  are  less  exposed 
to  infections,  because  they  spend  more 
time  out  of  doors,  and  that  their  homes, 
the  school-rooms,  churches,  public  halls 
of  assembly,  street-cars,  and  railroad 
coaches  are  all  wide  open  and  well  venti- 
lated, thus  reducing  the  danger  of  infec- 
tion to  the  minimum;  while  during  the 
winter  and  the  inclement  months  of  the 
spring  the  people  largely  remain  in-doors, 
and  their  homes,  places  of  business,  and 

141 


MOUTH  HYGIENE 

public  resorts,  including  the  school-rooms, 
the  churches,  street-cars,  and  railroad 
coaches,  are  heated  to  an  unnecessary  de- 
gree and  badly  ventilated.  As  a  result  the 
air  in  these  buildings  is  foul  and  loaded 
with  septic  organisms  from  the  mouths  of 
people  who  pay  no  attention  to  oral  clean- 
liness, or  who  are  suffering  from  some 
infectious  or  septic  oral,  throat,  bronchial, 
or  pulmonary  complaint,  the  germs  of 
which  find  lodgement  in  the  air-passages 
and  the  mouth  of  the  assembled  people 
and  establish  infections  that  would  be 
practically  impossible  out  of  doors  or  in 
well-ventilated  open  buildings  and  public 
conveyances. 

Periodic  attacks  of  tonsillitis  almost  in- 
variably accompany  an  unsanitary,  septic 
oral  cavitv.  This  has  been  a  matter  of 
such  convincing  observation  for  several 
years,  upon  the  part  of  the  writer,  that 
he  feels  like  saying  that  tonsillitis  is  never 
associated  wath  a  clean,  hygienic  mouth, 
except  from  direct  infection  through  un- 
clean instruments  of  the  oral  or  throat 
specialist. 

Pharyngitis,  laryngitis,  and  angina 
are    septic    inflanmiations    having    their 

142 


THROAT,  EAR.  AND   EYE 

origin  in  a  septic  condition  of  the  nasal 
or  oral  cavities,  but  most  frequently  from 
an  unclean  septic  mouth,  and  which  can  be 
prevented  in  a  large  majority  of  instances 
by  a  proper  attention  to  oral  cleanliness 
and  oral  hygiene. 

Very  much  has  been  written  during  the 
last  decade  upon  the  subject  of  the 
''Tonsils  as  Portals  of  Infection''  but  the 
question  as  to  what  extent  these  glands 
are  responsible  for  the  introduction  of  in- 
fectious materials  into  the  lymph  and 
blood  streams  is  by  no  means  settled. 
There  is  no  doubt  that  under  certain  con- 
ditions they  may  become  active  factors 
in  the  absorption  of  toxic  materials,  as 
in  diphtheria  and  scarlet  fever,  but  no 
more  so  than  the  mucous  membrane  and 
lymphoid  tissues  of  the  pharynx,  naso- 
pharynx, and  fauces. 

Some  authors  lay  so  much  stress  upon 
the  role  played  by  the  tonsils  as  gatherers 
and  disseminators  of  infectious  and  toxic 
materials  that  they  entirely  overlook  the 
possibility  and  the  probability  that  much 
of  the  general  infection  for  which  the 
tonsils  are  blamed  is  due  to  the  absorption 
of  pyogenic  organisms  and  toxins  by  the 

143 


MOUTH   HYGIENE 

mucous  membrane  and  lymphoid  tissues 
of  other  portions  of  the  throat  and  of  the 
mouth.  The  tissues  of  a  septic  mouth  are 
always  in  a  more  or  less  inflamed  con- 
dition, and  many  times  in  a  state  of  sup- 
puration and  ulceration;  these  conditions 
being  particularly  favorable  for  the  pro- 
duction of  toxins  and  for  the  absorption 
of  septic  materials. 

With  a  very  few  exceptions  no  mention 
is  made  in  these  articles  of  the  unsanitary 
mouth  and  the  role  it  plays  in  the  produc- 
tion of  septic  materials  and  as  a  portal 
of  infection.  The  septic  mouth  is  the  in- 
cubator from  which  the  tonsils  most  likely 
receive  their  infection  with  pyogenic 
micro-organisms  and  certain  toxins  elabo- 
rated by  the  saprophytic  germs. 

Packard  ^  is  a  notable  exception  in  this 
regard,  as  he  calls  especial  attention  to 
the  multitude  of  pathogenic  micro-organ- 
isms found  in  the  human  mouth,  and 
suggests,  "  With  such  an  array  of  micro- 
organisms in  the  mouth,  it  seems  as  though 
there  must  be  constant  infection  of  the 
mucous  membrane." 


*New  York  Medical  Journal,  June  24,  1899. 

144 


THROAT,  EAR,  AND   EYE 

Mayer  -  in  this  connection  says,  "  The 
strictest  attention  to  the  hygiene  of  the 
mouth  should  be  enjoined  even  after 
thorough  ablation  of  the  tonsils,"  thus  rec- 
ognizing the  possibility  of  infections  oc- 
curring through  other  tissues  than  the 
tonsils. 

The  spreading  of  diphtheria  is  much 
more  rapid  and  its  virulence  greater 
among  children  with  neglected  and  septic 
mouths  than  among  those  whose  mouths 
are  in  a  fairly  hygienic  condition.  The 
presence  of  the  bacillus  of  diphtheria  in 
the  human  mouth  was  first  observed  by 
Loffler  in  the  mouth  of  a  healthy  child. 
These  organisms  have  since  been  fre- 
quently found  in  the  mouths  of  healthy 
persons  and  seem  under  such  circum- 
stances to  do  no  harm.  Miller  ^  thinks 
that  this  fact  "  favors  the  view  that  the 
secretions  of  the  mouth  are  a  suitable 
nutrient  medium  for  the  germs  of  diph- 
theria, and  that  possibly  they  appear  in 
the  mouth  oftener  than  has  heretofore 
been   supposed,    reserving   their    specific 


'Journal   American    Medical    Association,   December, 
1899. 

'  Miller's  Micro-organisms  of  the  Human  Mouth,  p.  337. 

10  145 


MOUTH   HYGIENE 

action  until  certain  favorable  conditions 
prevail." 

The  Massachusetts  Associated  Boards 
of  Health  ^  found  in  some  recent  investi- 
gations that  the  Klebs-Loffler  bacillus  was 
present  in  the  throats  of  from  one  to  two 
per  cent,  of  all  healthy  persons,  and  in 
from  eight  to  fifty  per  cent,  of  all  those 
who  had  been  exposed  to  diphtheria  in 
families. 

How  very  important,  then,  becomes  the 
care  of  the  human  mouth  and  the  preser- 
vation of  its  tissues  and  secretions  in  a 
healthy  state!  Cleanliness,  first,  last,  and 
all  the  time,  should  be  the  watchword,  not 
only  in  the  nursery  of  the  well-to-do  and 
the  rich,  but  in  every  home  in  which  chil- 
dren abide,  particularly  in  the  homes  pro- 
vided for  the  indigent  children  of  our 
great  cities  and  commonwealths,  for  in 
these  places  neglect  of  oral  cleanliness  is 
most  likely  to  be  found. 

Albert  Mills  ^  found  that  "  the  micro- 
organisms in  the  saliva  in  general  in- 
creased the  virulence  of  imported  germs." 
The  fact  that  the  virulence  of  the  bacillus 


*  Medical  Record,  March  2,  1907. 

6  Ann.  Roy.  Soc.  de  Med.  et  Nat.  de  Brux.,  1896. 

14& 


THROAT,  EAR,  AND   EYE 

of  diphtheria  can  be  exalted  by  inocula- 
tion along  with  it  of  the  streptococcus 
pyogenes — a  pus  organism — is  very  preg- 
nant with  suggestion  (Alderson). 

In  this  connection  it  may  be  proper  to 
ask  if  the  bacillus  of  diphtheria,  of  tuber- 
culosis, of  cholera,  and  of  syphilis,  when 
transplanted  to  a  septic  mouth,  may  not 
have  their  virulence  greatly  increased  by 
growth  in  such  an  environment? 

Pommay  ^  says,  "  Virulence  is  not  a 
primitive  original,  and  necessary  condi- 
tion of  pathogenic  microbes;  it  is  an  ac- 
quired, contingent  condition,  which  pro- 
ceeds from  the  evolution  of  certain 
microbes  in  certain  conditions  and  soils. 
Of  culture  media  some  increase  or  create 
the  virulence;  others  attenuate  or  ex- 
tinguish it;  others  are  indifferent — that 
is,  neither  modify  nor  produce  it." 

Ellegood  "^  is  of  the  opinion  that  "  The 
life  processes  of  some  of  the  bacteria 
always  found  in  the  mouth  appear  at 
times  harmless,  and  at  others  malignant, 
in  the  sense  of  being  inimical  to  the 
healthy  conditions  of  the  tissues.    The  vital 


'Vicentini's  Bacteria  of  the  Sputum,  etc.,  p.  153. 
'Laryngology,  1906,  p.  270. 

147 


MOUTH  HYGIENE 

phenomena  of  some  of  this  class,  how- 
ever, as  well  as  of  numerous  species  whose 
occurrence  in  the  mouth  is  purely 
accidental,  are  under  certain  circum- 
stances distinctly  pathogenic." 

Dr.  Ackerly,^  of  London,  says,  "  I  am 
convinced,  after  holding  a  post  as  medical 
officer  to  an  isolation  hospital  for  many 
years,  that  the  severity  of  throat  symp- 
toms in  diphtheria  and  scarlet  fever,  and 
of  the  severity  of  an  attack  of  enteric 
fever,  depends  largely  upon  the  presence 
or  absence  of  oral  sepsis;  and  in  such  a 
disease  as  appendicitis  there  is  much 
reason  to  believe  that  oral  sepsis  has  much 
to  do  \^ath  the  more  severe  cases  in  which 
a  catarrhal  affection  rapidly  becomes  a 
purulent  inflammation.  The  extraordi- 
narily rapid  improvement  which  takes 
place  in  the  dyspepsias  and  other  troubles 
of  the  people  when  there  is  only  slight 
sepsis  when  this  is  attended  to,  by  itself 
justifies  such  attention  and  makes  delay 
blameworthy." 

He  says,  further,^  "  When  patients 
admitted  with  diphtheria  had  clean  mouths 

^British  Journal  Dental  Science,  July,  1910,  p.  586. 
^British  Journal  Dental  Science,  July,  1910,  p.  599. 

148 


THROAT,  EAR,  AND   EYE 

and  good  teeth,  the  pathologist  reported 
that  cultivations  from  the  throat  showed 
a  pure  or  almost  pure  culture  of  the  diph- 
theria bacillus;  but  when  the  mouth  was 
dirtv,  the  culture  showed  a  mixed  in- 
fection  and  the  type  of  disease  was  severe. 
In  cases  of  typhoid,  too,  it  made  an  enor- 
mous difference  whether  the  mouth  was 
clean  or  dirty,  on  the  course  of  the 
disease." 

Rosenow,^^  the  noted  bacteriologist  of 
Chicago,  has  found  that  by  changing  the 
environment  of  a  specific  micro-organism, 
its  specific  action  may  be  changed.  By 
varying  the  degrees  of  oxygen  tension 
alone,  upon  members  of  the  streptococcus 
group,  changes  in  virulence  occur,  and 
they  acquire  different  affinities  for  vari- 
ous structures. 

Diseases  of  the  ear  of  septic  origin 
are  frequently  associated  with  an  unclean 
and  septic  oral  cavity,  particularly  those 
conditions  w^hich  are  dependent  upon  the 
staphylococci,  streptococci,  and  the  pneu- 
mococci  as  sources  of  infection.  The 
nasal  passages  are  almost  never  free  from 
these  organisms,  and  it  is  quite  probable 

"  Journal  American  Medical  Association,  vol.  63,  p. 
2027. 

149 


MOUTH  HYGIENE 

that  many  middle-ear  affections  are  due 
to  the  presence  of  these  organisms  located 
primarily  in  these  passages.  The  oral 
cavity  is,  however,  never  free  from  septic 
organisms,  and  when  it  is  in  a  neglected, 
unsanitary  condition,  it  is  a  veritable  hot- 
bed of  infection,  sw^arming  ^\dth  myriads 
of  septic  organisms  which  infect  the 
tonsils,  the  pharynx,  the  nasopharynx,  the 
larynx,  the  trachea,  the  bronchial  tubes, 
the  lungs,  the  stomach,  and  the  intestines. 

The  micro-organisms  of  a  septic  oral 
cavity  travel  from  the  mouth  to  the  ton- 
sils and  pharynx,  from  the  pharynx  to 
the  nasopharynx,  from  the  nasopharynx 
to  the  Eustachian  tubes,  and  thus  reach 
the  middle  ear.  It  is  possible  also  for  the 
pyogenic  organisms  in  the  mouth  to  reach 
the  tissues  of  the  middle  ear  through  the 
blood  and  lymph  streams. 

In  this  connection  the  history  of  the 
following  case  will  be  of  interest;  Mrs. 
G.,  the  mother  of  a  medical  friend,  had 
for  sixteen  years  been  troubled  with  an 
offensive  discharge  from  the  left  nostril. 
Prior  to  this  she  had  suffered  intensely 
from  pain  and  swelling  in  the  region  of 
the  left  maxillary  sinus,  which  lasted  for 

150 


THROAT,  EAR  AND  EYE 

several  weeks  and  then  subsided.  This 
condition  was  accompanied  by  a  profuse 
discharge  of  offensive  secretions  from  the 
left  nostril.  Later  the  swelling  dis- 
appeared, but  the  discharge  never  wholly 
ceased.  Six  years  after  the  first  attack, 
the  face  again  became  very  painful  and 
much  swollen,  this  time  extending  far- 
ther back,  finally  developing  what  was 
thought  to  be  abscess  of  the  middle  ear. 
Large  quantities  of  pus  were  discharged 
from  the  ear  through  the  external  meatus, 
and  at  one  time  it  was  feared  that  the 
suppurative  process  would  extend  to  the 
meninges  of  the  brain.  After  several 
weeks  of  intense  suffering  the  symptoms 
subsided  and  finally  the  discharge  from 
the  ear  entirely  ceased.  After  this,  how- 
ever, the  discharge  from  the  left  nostril 
seemed  to  be  increased  and  the  symptoms 
were  always  aggravated  by  taking  cold. 
The  teeth  upon  the  left  side  of  the  upper 
jaw  had  all  been  extracted  one  by  one 
as  a  possible  cause  of  the  trouble,  except 
the  third  molar,  which  had  never  erupted. 
This  procedure,  however,  produced  no 
abatement  of  the  symptoms.  Later  the 
teeth  of  the  opposite  side  were  removed 

161 


MOUTH  HYGIENE 

for  the  purpose  of  inserting  a  complete 
upper  artificial  denture.  About  ten  years 
after  the  last-mentioned  attack,  while 
leaning  over  a  wash-bowl,  brushing  her 
teeth,  she  suddenly  noticed  that  the  left 
nostril  was  plugged  up  by  some  movable 
body.  On  throwing  the  head  backward 
in  an  attempt  to  dislodge  it,  the  mass  fell 
into  the  fauces,  and  was  ejected  from  the 
mouth  into  the  bowl.  Upon  examination, 
it  proved  to  be  a  well-developed  left  supe- 
rior third  molar,  more  or  less  covered  with 
hard  concretions  of  a  dark-brown  color. 
The  discharge  from  the  nose  from  this 
time  on  grew  gradually  less,  and  finally, 
after  a  few  months,  ceased  altogether. 

The  probable  explanation  of  the  pecu- 
liar features  of  this  case  are,  briefly :  first, 
the  third  molar  was  developed  in  an  in- 
verted position,  and  very  near  to  the  floor 
of  the  maxillary  sinus.  Second,  suppura- 
tive inflammation  was  established  in  the 
crypt  of  the  tooth  germ  from  irritation 
induced  by  its  development  in  an  ab- 
normal position  and  the  lodgement  and 
multiplication  of  pyogenic  organisms 
floating  in  the  blood  or  lymph  streams. 
Third,  the  pus  cavity  ruptured  into  the 

152 


THROAT,  EAR  AND  EYE 

maxillary  sinus.  Fourth,  the  abscess  of 
the  middle  ear  may  have  been  an  exten- 
sion of  the  tooth  abscess,  though  there 
is  some  doubt  as  to  this,  as  the  anatomy 
of  the  parts  does  not  readily  favor  such  a 
supposition.  The  more  probable  exj)lana- 
tion  of  the  otitis  media  is  that  of  infection 
through  the  blood  and  lym])h  streams. 
The  tooth  ])robably  became  lodged  against 
the  nasal  wall  of  the  sinus,  causing  ul- 
ceration and  destruction  of  bone,  which 
finally  permitted  it  to  pass  into  the  nasal 
cavity,  and  thus  be  expelled. 

Inflation  of  the  Eustachian  tubes  in  the 
presence  of  a  sejitic  oral  cavity  with  almost 
certain  infection  of  the  nasopharynx  by 
extension,  is  a  dangerous  procedure,  and 
should  never  be  undertaken  until  the 
dangers  of  a  virulent  infection  have  been 
removed  by  proper  treatment  of  the  septic 
condition  of  the  mouth. 

Pain  in  the  ears  is  a  frequent  accom- 
paniment of  dental  diseases,  particularly 
of  acute  pulpitis,  pericemental  irritation, 
difhcult  eru])tion  of  individual  teeth,  and 
impaction  of  the  third  molars.  Little 
children  frequently  suffer  during  denti- 
tion   from    rellex    pain    in    the    ears — 

153 


MOUTH  HYGIENE 

otalgia — due  to  pressure  upon  the  gingi- 
val nerves  during  the  eruption  of  the 
teeth,  particularly  the  molars. 

In  adults  the  otalgia  is  most  frequently 
associated  with  an  acute  pulpitis  or  an 
acute  pericementitis.  These  conditions 
present  no  difficulties  in  diagnosis  to  the 
dental  surgeon  or  the  otologist,  and 
appropriate  dental  treatment  gives  im- 
mediate relief;  but  the  more  rare  con- 
dition of  aural  pain  dependent  upon  the 
irritation  of  an  impacted  third  molar 
often  presents  most  perplexing  symptoms. 
The  most  critical  examination  of  the  ear 
may  give  absolutely  negative  results, 
while  a  most  thorough  examination  of  the 
mouth  and  teeth  may  give  no  enlighten- 
ment upon  the  cause,  except  perhaps  the 
absence  of  a  third  molar  upon  the  affected 
side.  Under  such  circumstances  the 
Roentgen  ray  will  decide  the  question  of 
the  presence  or  absence  of  the  missing 
tooth  and  its  position  if  present.  Many 
times,  however,  the  presence  of  the  tooth 
is  easily  demonstrated  by  the  aid  of  a  fine 
steel  probe,  as  usually  a  small  opening 
can  be  found  in  the  gum  close  to  the 
posterior  sur^face  of  the  second  molar, 

154 


THROAT,  EAR  AND  EYE 

that  leads  to  the  crown  of  the  trouble- 
some tooth.  Cases  of  this  character  call 
for  operation  at  the  hands  of  an  expert 
oral  surgeon.  The  removal  of  the  tooth 
usually  cures  the  otalgia. 

Diseases  of  the  eye  associated  with 
septic  conditions  of  the  oral  cavity  may 
arise  in  three  ways:  First,  by  direct  ex- 
tension of  disease,  as  in  a  case  of  purulent 
empyema  of  the  maxillary  sinus  ruptur- 
ing into  the  orbit,  or  by  cellulitis  of  the 
cheek,  or  an  osteomyelitis  of  the  upper 
jaw,  caused  by  dento-alveolar  abscess,  or 
by  the  migration  of  septic  organisms  from 
the  mouth  through  the  nasal  passages  and 
into  the  lachrymal  canal  and  then  into 
the  conjunctival  sac.  Second,  by  the 
passage  of  septic  organisms  into  the  blood 
and  lymph  streams  and  the  establishment 
in  the  optic  tissues  of  metastatic  foci  of 
infection.  Third,  by  reflex  irritation 
through  the  fifth  nerve,  due  to  dental 
caries,  hyper^emia  of  the  pulp,  interstitial 
calcification  of  the  pulp — pulp  stones — 
acute  and  chronic  pulpitis,  acute  and 
chronic  pericementitis,  pressure  upon  the 
gingival  nerves  in  tooth  eruption,  im- 
pacted third  molars,  crowding  of  the  teeth, 

155 


MOUTH  HYGIENE 

as  in  cases  of  irregularities,  where  the 
jaw  is  too  small  for  the  teeth,  and  in  the 
too  rapid  movement  of  the  teeth  by 
orthodontia  appliances. 

Cases  of  suppurative  inflammation  in- 
volving the  orbit  and  the  tissues  of  the 
eye,  by  extension  from  diseased  teeth,  such 
as  cellulitis  of  the  cheek,  purulent  em- 
pyema of  the  maxillary  sinus,  and  osteo- 
myelitis of  the  upper  maxilla,  are  exceed- 
ingly dangerous,  as  they  may  cause  loss 
of  the  eye,  or  the  infection  may  extend 
to  the  cranial  cavity  and  cause  death  by 
septic  inflammation  of  the  meninges  of 
the  brain.  Fortunately,  diseases  of  this 
character  are  not  at  all  frequent. 

Diseases  due  to  reflex  irritation  are 
much  more  common  and  numerous,  but 
it  is  sometimes  very  difficult  to  establish 
a  positive  diagnosis.  Many  times  this  can 
be  done  only  by  a  process  of  exclusion. 
This  arises  in  some  instances  from  the  un- 
certainty as  to  the  point  at  which  the  re- 
flex pain  may  be  expressed.  It  has  been 
learned  from  observation  that  in  hip- joint 
disease  the  pain  is  usually  expressed  at 
the  inner  side  of  the  knee,  that  in  iritis 
the  pain  is  usually  located  in  the  eyebrow, 

156 


THROAT,  EAR  AND  EYE 

while  In  cancer  of  the  larynx  It  Is  expressed 
in  the  ear.  A  dental  pulpitis  may  cause 
pain  in  the  ear  or  the  side  of  the  face,  or 
in  the  parotid  gland,  or  in  the  eye,  causing 
a  profuse  lachrymation.  On  the  other 
hand,  diseases  of  the  eye  have  been  known 
to  cause  reflex  pain  in  the  teeth/^ 

Among  the  diseases  of  the  eye  which 
have  been  traced  to  dental  irritation  are 
iritis,  conjunctivitis,  kerato-scleritis,  optic 
neuritis,  herpetic  eruption  upon  the  cor- 
nea, strabismus,  amblyopia,  glaucoma, 
amaurosis,  ptosis,  paralysis  of  accommo- 
dation, spasms  of  the  muscles  of  the  lids, 
and  paresis. 

An  interesting  case  of  amaurosis  de- 
pendent upon  dental  irritation  was  pub- 
lished in  the  Journal  of  the  American 
Medical  Association,  volume  i,  page  637. 

History. — The  patient,  Mrs.  L.,  34 
years  of  age,  in  fairly  good  health,  was 
seized  with  severe  pain  in  the  left  eye 
and  great  soreness  in  the  left  superior 
bicuspid  tooth  which  had  been  filled  about 
two  years  before.  She  had  suffered  for 
some  little  time  a  serious  difficulty  with  the 
left  eye,  involving  partial  loss  of  sight,  pro- 
fuse  lachrymal  discharge,  and  severe  par- 

"  Galezomsky,  Journal  d'ophth,  1872. 

157 


MOUTH  HYGIENE 

oxysmal  pain.  She  stated  that  for  several 
weeks  after  the  tooth  was  plugged  there 
was  slight  uneasiness  in  the  tooth,  with 
sensitiveness  upon  sudden  changes  of  tem- 
perature, such  as  were  produced  by  taking 
hot  or  cold  drinks  into  the  mouth,  but 
nothing  so  marked  as  to  require,  in  her 
judgment,  any  attention,  and  these  symp- 
toms finally  passed  away.  In  about  six 
months  after  the  operation  upon  the  tooth 
she  begun  to  experience  pain  in  the  left 
eye,  of  intermittent  character,  increased 
flow  of  tears,  and  some  slight  obstruction 
of  sight.  Consulted  an  eminent  specialist 
in  New  York,  who,  after  careful  examina- 
tion of  the  eye,  could  find  no  local  cause 
for  the  difficulty  and  prescribed  con- 
stitutional treatment.  There  being  no 
improvement  after  several  weeks,  con- 
sulted him  again,  with  the  same  results. 
On  returning  to  Chicago,  she  consulted 
a  leading  ophthalmologist,  who  could  find 
no  local  cause  for  the  difficulty  and 
thought  it  must  be  systemic.  The  symp- 
toms had  for  months  gradually  grown 
worse,  so  that  she  had  been  obliged  to 
give  up  reading  and  A\Titing,  as  all  such 
efforts    aggravated   the    symptoms.      In 

158 


THROAT,  EAR  AND  EYE 

this  condition  she  again  visited  the  New 
York  opthahnologist.  After  a  third 
careful  and  most  painstaking  examina- 
tion, he  said  he  could  find  no  sufficient 
local  cause  for  the  symptoms  complained 
of,  and  that  he  could  do  nothing  for  her 
except  what  might  be  hoped  for  through 
constitutional  treatment.  The  history  of 
the  case  being  so  remarkable,  her  dentist 
decided  to  ascertain  the  condition  of  the 
pulp  of  the  tooth  referred  to.  On  ex- 
cavating the  cavity  he  found  the  bulbous 
portion  of  the  pulp  cavity  filled  with 
secondary  dentine  quite  up  to  a  line 
corresponding  to  the  line  of  the  alveolus. 
Above  this  the  pulp  was  in  a  state  of  low 
inflammation.  As  the  instrument  pierced 
the  pulp,  the  sensation  was  communicated 
to  the  eye,  causing  a  paroxysm  of  pain. 
The  previous  removal  of  the  filling  had 
given  some  relief  from  pain  in  the  eye 
and  the  soreness  of  the  tooth  had  been 
considerably  relieved.  After  removing 
the  pulp,  which  he  did  at  once,  and  treat- 
ing the  tooth  for  a  few  days,  the  pulp 
canal  and  the  cavity  of  decay  were  filled. 
The  case  began  to  improve  at  once,  and 
in  a  few  weeks  the  sight  was  restored  to 

159 


MOUTH  HYGIENE 

its   normal   condition   and   all   the  other 
symptoms  had  passed  away. 

The  periodical  literature  upon  diseases 
of  the  eye  due  to  dental  irritation  of  vari- 
ous forms  is  quite  voluminous,  particu- 
larly upon  irritation  from  dental  caries, 
pulpitis  both  acute  and  chronic,  and  sep- 
tic conditions  of  the  pulp  canals  and  roots 
of  the  teeth. 

Infectiont  of  the  Cervical  Glands. — 
Inflammation  and  enlargement  of  the 
cervical  glands  is  a  frequent  accompani- 
ment of  a  septic  oral  cavity,  especially 
with  suppurative  conditions  of  the  teeth, 
like  dento-alveolar  abscess  and  pyorrhoea 
alveolaris,  and  of  suppurative  and  ulcera- 
tive conditions  of  the  gums  and  oral  mu- 
cous membrane,  as  in  gingivitis  and 
stomatitis.  The  mouth  is  a  veritable  in- 
cubator for  the  growth  of  septic  organisms 
which  sooner  or  later  find  their  way  into 
the  submaxillary  and  cervical  glands 
through  the  lymph  channels  and  set  up 
inflammation,  thus  preparing  the  way  for 
that  arch-enemy  of  mankind,  the  tuber- 
cule  bacillus.  This  enemy  is  always 
arrayed  at  the  portals  of  the  citadel,  armed 
and  equipped  and  ever  watchful  to  take 

160 


THROAT,  EAR  AND  EYE 

advantage  of  any  mistake  in  strategy  or 
weakness  in  the  defence.  The  almost  con- 
stant presence  of  the  bacillus  tuberculosis 
in  the  mouth  renders  it  certain  that  much 
of  the  glandular  involvement  of  this  re- 
gion comes  from  or  through  an  infection 
from  the  mouth. 

Neglect  of  the  mouth  and  teeth  of  chil- 
dren is  one  of  the  chief  causes  of  septic 
and  tubercular  abscess  of  the  cervical 
lymphatic  glands,  and  prepares  the  way 
for  a  general  invasion  of  the  tubercle  ba- 
cillus and  the  establishment  of  tubercular 
bone  diseases,  pulmonary  tuberculosis,  etc. 

Tuberculosis  enters  the  system  by  three 
avenues : 

1st.  By  the  lungs,  through  direct  in- 
halation of  the  specific  organism  in  dried 
sputum. 

2d.  By  the  lymphatic  glands  of  the  in- 
testines, through  the  presence  of  the  or- 
ganisms in  foods  and  drinks. 

,3d.  By  the  lymphatic  tissue  of  the 
mouth  and  throat,  through  the  constant 
presence  of  these  organisms  in  the  mouth. 
(Sims  Woodhead.) 

The  most  common  causes  of  the  en- 
largement of  the  submaxillary  and  cervi- 

11  161 


MOUTH  HYGIENE 

cal  glands  are  infections  from  devitalized 
teeth  containing  gangrenous  and  putre- 
fying pulps,  chronic  dento-alveolar  ab- 
scesses, chronic  suppurative  gingivitis, 
ulcerative  stomatitis,  and  pyorrhoea  al- 
veolaris.  Chronic  aiFections  are  much 
more  liable  to  produce  glandular  enlarge- 
ments and  suppurative  inflammations 
than  are  acute  aiFections,  like  acute  dento- 
alveolar  abscess,  acute  gingivitis,  or  an 
acute  stomatitis.  Many,  very  many,  cases 
of  glandular  enlargement  located  in  the 
submaxillary  and  cervical  regions  have 
been  referred  to  the  writer  for  diagnosis 
and  treatment,  and  in  almost  every  in- 
stance a  suppurating  lesion  has  been  found 
in  the  mouth, — most  often  a  diseased 
tooth,  the  treatment  of  which  from  the 
aseptic  stand-point  or  its  extraction  has 
been  sufficient  to  cure  the  glandular  en- 
largement. In  a  very  few  instances  the 
mouth  has  shown  no  evidences  of  a  sup- 
purative lesion.  In  these  cases  inquiry 
has  sometimes  elicited  the  fact  of  a  recent 
attack  of  tonsillitis  which  explained  the 
glandular  enlargement. 

Many  delicate  children,  who  are  poorly 
nourished,  with  perverted  appetites,  pale 

162 


THROAT,  EAR  AND  EYE 

and  pasty  complexions,  peevish  and  fret- 
ful in  disposition,  dull  in  mind,  acutely  sus- 
ceptible to  changes  in  temperature  and  hu- 
midity, and  with  enlarged  submaxillary  or 
cervical  glands,  are  sufferers  from  chronic 
toxsemia  due  to  an  unsanitary  and  septic 
mouth.  The  placing  of  the  mouth  of  such 
a  child  in  a  hygienic  condition  will  in  a 
few  weeks  produce  a  marvellous  change 
in  body  and  mind,  and  will  convince  the 
most  skeptical  of  the  value  of  a  clean  and 
healthy  mouth  as  a  factor  in  the  general 
health  of  the  body  and  mind.  Did  the 
size  of  this  little  volume  permit,  numerous 
instances  from  the  practice  of  the  writer 
might  be  cited  in  proof  of  this  statement. 
Cases  of  this  character  are  so  numerous 
that  there  should  be  no  trouble  in 
verification. 


CHAPTER  XI. 

diseases  of  the  stomach,  intestines, 

and  other  viscera  caused 

by  oral  sepsis. 

Diseases  of  the  stomach  and  intes- 
tines associated  with  faults  in  digestion 
are  usually  attributed  to  catarrhal  affec- 
tions, induced  by  indiscretions  in  eating 
and  drinking,  overwork,  worry,  sedentary 
habits,  lack  of  exercise,  mental  shock, 
general  ill  health,  improper  mastication  or 
insufficient  mastication  due  to  painful 
teeth,  decayed  teeth,  or  loss  of  teeth. 
In  view  of  our  knowledge,  however, 
of  the  enormous  number  of  micro-organ- 
isms growing  in  a  septic  oral  cavity,  and 
of  the  fact  that  a  considerable  propor- 
tion of  them  are  pathogenic  in  char- 
acter and  sometimes  of  great  virulence, 
sepsis  as  a  cause  must  be  added  to  the 
above  list. 

The  long-continued  ingestion  of  myri- 
ads of  septic  and  fermentative  bacteria, 
during  the  preparation  of  the  food  by 
mastication  and  insalivation  for  the  pro- 
cess of  digestion,  and  during  the  intervals 

164 


DISEASES   OF  THE   STOMACH 

between  the  taking  of  food,  cannot  but 
prove  detrimental  and  positively  harmful 
to  the  process  of  digestion  and  to  the  integ- 
rity of  the  gastric  and  intestinal  mucous 
membrane  and  their  glandular  structures. 
We  wonder  sometimes  why  glandular  infec- 
tions of  these  tissues  are  not  more  com- 
mon and  why  the  results  of  these  infec- 
tions are  not  more  disastrous  to  the  health 
and  general  welfare  of  the  human  body 
than  they  are.  This  is  partially  explained 
by  the  fact  that  the  human  saliva  has 
under  certain  circumstances  an  inhibitive 
effect  upon  the  growth  and  virulence  of 
these  organisms ;  and  that  under  other  cu'- 
cumstances  they  accelerate  their  growth 
and  increase  their  virulence.  Further- 
more there  are  periods  in  the  life  of  the 
individual  when  the  susceptibility  to  dis- 
eases is  of  greater  or  less  degree  than  at 
other  times,  or  there  may  be  complete 
immunity  established. 

It  is  true  also  that  the  free  hydrochloric 
acid  of  the  gastric  juice  will  destroy  the 
vitality  of  many  of  the  germs  entering 
the  stomach  and  thus  protect  itself  against 
their  irritating  and  septic  effects.  There 
are  certain  organisms,  however, — such  as 

165 


MOUTH  HYGIENE 

the  tubercule  bacillus,  that  is  enclosed  in 
a  protecting  envelope  or  capsule, — that 
may  pass  through  the  stomach  and  intes- 
tines entirely  unharmed. 

Ordinarily  the  growth  of  the  putrefac- 
tive and  zymogenic — fermentative — or- 
ganisms is  inhibited  in  the  gastric  juice, 
but  when  this  fluid  is  weak  in  hydrochloric 
acid  (HCl)  or  when  the  number  of  the 
ingested  germs  is  so  great  as  to  over- 
whelm the  corrective  action  of  the  acid, 
putrefaction  and  fermentation  are  set  up 
in  the  stomach,  causing  irritation  and  in- 
flammation of  its  glandular  structures  and 
the  establishment  of  a  condition  of  gastric 
catarrh,  chronic  indigestion,  or  dyspepsia. 

If,  on  the  other  hand,  the  mouth  is  the 
seat  of  suppurative  conditions  such  as  in 
certain  forms  of  gingivitis  and  stomatitis, 
or  suppuration  associated  with  dento- 
alveolar  abscess  and  pyorrhoea  alveolaris, 
or  with  extensive  dental  decay  and  gan- 
grenous and  sloughing  dental  pulps,  which, 
as  already  stated,  furnish  the  most  virulent 
septic  organisms,  septic  inflammation  of 
the  glandular  structures  of  the  stomach 
may  be  established — the  septic  gastritis 
of  Hunter — by  infection.  These  septic 
conditions  not  infrequently  pass  on  to  the 

166 


DISEASES   OF  THE  STOMACH 

intestines,  attacking  the  glandular  struc- 
tures and  setting  up  an  enteritis,  or  ap- 
pendicitis, or  colitis.  The  infection  may 
also  extend  to  the  bile  and  pancreatic 
ducts,  setting  up  a  cholecystitis  or  a 
pancreocystitis.  (Probyn.)  It  is  not  at 
all  improbable  that  many  cases  of  gastric 
and  intestinal  ulcer  might  be  traced  to 
infection  of  the  glands  of  the  stomach  and 
intestines  from  the  virulent  pus  organisms 
of  a  septic  mouth. 

Furthermore,  the  bronchial  tubes  and 
the  lungs  are  subject  to  septic  infection 
from  an  unsanitary  mouth.  Septic 
pneumonia  is  by  no  means  an  uncommon 
sequela  of  the  administration  of  the  gen- 
eral ansesthetics  through  entrance  of 
particles  of  septic  material  and  micro- 
organisms to  the  pulmonary  structures 
during  the  stertorous  breathing  of  nar- 
cosis. Miller  ^  is  of  the  opinion,  as  also 
Frankel,  Weichselbaum,  and  Baumgar- 
ten,  that  lobar  pneumonia  is  in  all  prob- 
ability an  infection  from  the  mouth  due  to 
the  coccus  of  sputum  septicaemia — pneu- 
mococcus. 

Miller    quotes    Isreal  ^    as    furnishing 


^Micro-organisms  of  the  Human  Mouth,  pp.  261,  262. 
^Micro-organisms  of  the  Human  Mouth,  p.  299. 

167 


MOUTH  HYGIENE 

striking  proof  of  the  correctness  of  the 
supposition  that  pulmonary  diseases  may 
occur  from  the  inspiration  of  pathogenic 
germs  of  the  mouth.  In  a  case  of 
primary  actinomycotic  infection  of  the 
lungs,  Isreal  found  a  small  irregular  body 
resembling  a  piece  of  dentine,  which  he 
sent  Miller  for  examination.  It  was 
found  to  consist  of  a  fragment  of  den- 
tine— ^tooth  bone — surrounded  by  a  chalky 
mass,  composed  of  phosphate  and  carbon- 
ate of  lime,  presumably  tartar — salivary 
calculus.  The  microscope  revealed  nu- 
merous threads  of  the  ray  fungus — the 
organism  which  produces  lumpy  jaw  in 
cattle — and  there  can  be  little  doubt  that 
the  fragment  of  dentine  was  the  carrier 
of  the  infection. 

Baumgarten  ^  reports  a  similar  case  of 
primary  actinomycosis  of  the  lung,  with 
secondary  extension  to  the  soft  tissues  of 
the  thoracic  wall,  by  the  inspiration  of 
the  specific  fungal  elements  growing  in 
the  lacunae  of  the  left  tonsil. 

Septic  inflammation  of  the  tonsils,  of 
the  pharynx,  of  the  uvula,  and  of  the 
larynx  are  all  usually  due  to  a  direct  in- 

'  Micro-organisms  of  the  Human  Mouth,  p.  299. 

168 


DISEASES   OF   THE   STOMACH 

fection  from  the  pyogenic  organisms 
found  in  the  mouth,  as  are  also  gingivitis, 
stomatitis,  and  the  local  inflammatory 
manifestations  of  pyorrhoea  alveolaris. 

The  diseases  which  may  arise  by  indirect 
infection  through  the  absorption  of  the 
septic  mouth  organisms  and  their  entrance 
into  the  blood  and  l}Tnph  channels  are 
exceedingly  numerous;  in  fact,  this  pos- 
sibility covers  the  entire  range  of  all  the 
pyogenic  diseases,  the  more  serious  of 
which  are  osteomyelitis,  ulcerative  endo- 
carditis, septic  nephritis,  septic  empyema, 
septic  meningitis,  acute  septicaemia, 
pyaemia,  erysipelas,  metastatic  abscesses, 
diabetes,  neuritis,  tri- facial  neuralgia,  etc. 

Dr.  R.  Ackerly,  of  London,  in  a  recent 
lecture  before  the  Royal  Society  of  Medi- 
cine upon  "  Observations  on  the  Condi- 
tion of  the  INIouth  in  1000  Consecutive 
Cases  of  Chronic  Diseases,"^  says:  The 
real  object  of  the  lecture  was  to  show  the 
conditions  of  the  teeth  and  oral  cavity 
which  prevail  in  those  patients  who  are 
suffering  from  chronic  diseases;  how  the 
teeth  were  used;  and  the  effects  of  im- 
proper mastication.     He  says:  "Before 

*  British  Journal  Dental  Science,  July,  1910,  pp.  570-590. 

169 


MOUTH   HYGIENE 

giving  an  analysis  of  the  cases,  I  wish  to 
say  that  over  90  per  cent,  were  really 
well-to-do  people.  Not  2  per  cent,  of 
them  suggested  that  want  of  means  pre- 
vented them  having  their  teeth  put  right, 
and  the  vast  majority  of  them  were  going 
to  a  doctor  or  a  dentist  more  or  less 
regularly." 

In  the  table  of  the  results  presented 
he  says:  "I  have  adopted  certain  head- 
ings. Excellent  means  a  mouth  contain- 
ing all  the  teeth  in  a  good  state  of  pres- 
ervation, with  or  without  all  the  wisdom 
teeth,  w^ith  no  gaps,  and  with  only  few 
stoppings.  Very  good  would  mean  teeth 
with  practically  all  grinding  surfaces  in- 
tact, even  though  many  have  been  stopped. 
Good  is  applied  to  a  mouth  ^vith  the  loss 
of  not  more  than  three  molars  altogether, 
i.  e.,  of  not  more  than  about  25  per  cent,  to 
30  per  cent.,  or  teeth  where  the  gaps,  if 
large,  are  filled  by  satisfactory  artificial 
teeth.  Fairly  good,  if  the  grinding  sur- 
face is  not  diminished  by  more  than  50 
per  cent.  With  less  than  this  I  call  them 
defective, 

"  In  the  1000  cases  observed,  9 
cases,  or  0.9  per  cent.,  are  described  as 

170 


DISEASES   OF   THE   STOMACH 

*  excellent ' ;  22  cases,  or  2.2  per  cent.,  are 
described  as  'very  good';  198  cases,  or 
19.8  per  cent.,  as  '  good  ';  74  cases,  or  7.4 
per  cent.,  as  '  fairly  good.'  That  is,  303, 
or  30.3  per  cent.,  are  either  really  good  or 
fairly  satisfactory,  and  provide,  taking 
not  too  high  a  standard,  teeth  sufficiently 
good  for  mastication. 

"  The  '  defective '  mouths  numbered 
360,  36  per  cent.;  septic, — i.  e.,  obviously 
septic  w^ithout  the  minute  examination 
given  in  a  dentist's  chair, — 227,  or  22.7 
per  cent.,  with  0.8  in  addition  marked 
septic  with  a  query.  Of  these  185,  or  18.5 
per  cent.,  were  both  septic  and  defective; 
the  rest — i.  e.,  42 — had  septic  gums  with 
rotten  stumps  covered  by  plates.  In  many 
of  the  septic  cases  there  were  smaller 
plates,  but,  as  explained,  I  recorded  plates 
only  when  they  supply  50  per  cent,  of 
the  teeth. 

"  As  regards  plates  87,  or  8.7  per  cent., 
are  described  as  good;  250,  as  plates  only; 
and  20  are  recorded  as  being  definitely 
bad  as  plates,  and  are  classed  also  as 
defective." 

This,  he  thinks,  "  is  rather  a  serious 
state  of  affairs  considering  the  class  of 

171 


MOUTH  HYGIENE 

patients."  Had  a  hospital  or  less  well-to- 
do  class  formed  the  basis  of  the  investiga- 
tion, he  "  had  abundant  evidence  that  the 
septic  and  defective  sections  would  be 
enormously  increased."  "  Is  it  not  a  re- 
proach," he  asks,  "  to  us  as  a  profession 
that  more  than  one  in  three  people  in 
contact  with  medical  men  and  dentists, 
and  often  in  contact  with  men  of  some 
note,  should  be  so  badly  equipped  for  so 
necessary  a  function  as  mastication?  But 
that  more  than  one  in  five  should  possess 
a  foul  mouth  is  still  worse.  And  what 
makes  it  worse  is  that  this  condition  is 
deliberately  allowed  by  doctor  and 
dentist." 

"If  careful  mastication  is  necessary 
for  those  whom  we  choose  to  call  healthy, 
because  they  are  in  the  vigor  of  youth 
or  have  no  marked  pathological  symptoms, 
surely  it  is  much  more  obviously  necessary 
for  those  who  are  failing  in  health  and 
whose  nutrition  is  imperfect,  especially  in 
the  large  groups  of  chronic  diseases  in 
which  there  are  marked  dyspeptic  symp- 
toms or  faulty  metabolism.  This  includes 
all  the  diseases  of  stomach,  bowels,  liver, 
pancreas,  and  directly  or  indirectly  most 

172 


DISEASES   OF  THE   STOMACH 

cardiac    complaints;    the    conditions    de- 
scribed as  gouty  and  rheumatic;  and  all 
those  in  which  there  is  obesity  or  wasting*, 
or  tendency  to  waste.     Quite  apart  from 
the  definite  evils  following  the  swallowinsr 
of  lumps  of  food,  or  imperfectly  salivated 
food,  is  it  not  obvious  in  these  cases  that 
it   is   only   by   attention   to   mastication, 
whatever  else  we  do,  that  we  can  hope 
to  improve  the  impaired  nutrition?     A 
great  deal  of  attention  has  been  bestowed 
to  the  dietary  of  sufferers  from  chronic 
complaints,  and  it  is  quite  common  for 
patients   to   be   supplied   with   a   list   of 
articles  of  food  that  they  must,  or  must 
not,  eat ;  but  very  rarely  indeed  do  I  find 
that  they  are  told,  as  I  find  it  is  often 
necessary  to  tell  them,  '  It  is  far  less  im- 
portant what  you  eat  than  how  you  eat 
it.'  "     This  is  the  great  principle  which 
underlies  the  teaching  of  Mr.  Fletcher. 

Dr.  Ackerly  further  says:  "We  may 
take  it  as  agreed  that  thorough  mastica- 
tion is  important.  That  being  the  case, 
one  would  expect  that  the  medical  advisers 
of  the  people  would  as  far  as  possible 
insist  upon  attention  to  the  condition  of 
the  teeth,  the  removal  of  defective  teeth, 

173 


MOUTH  HYGIENE 

especialh^  if  septic,  and  the  correction  of 
any  mechanical  impediment  to  mastica- 
tion. These  are  the  cases  usually  found 
at  the  hospital.  JNIany  of  them  are  cases 
of  very  considerable  duration,  having  been 
under  treatment  for  many  years,  often 
by  several  doctors,  and,  on  the  whole,  the 
patients  are  genuinely  anxious  to  obtain 
and  follow  advice  which  is  given  to  them 
with  any  show  of  reason  fortified  by  con- 
viction. They  are  suffering  from  various 
forms  of  dyspepsia,  affections  of  the 
stomach  and  bowels,  rheumatism,  gout, 
so-called  rheumatoid  arthritis,  arterio- 
sclerosis, neurasthenia,  and  the  majority 
of  them  are  past  middle  life." 

Dr.  Brandon  reports  the  following 
case:  ^  "Mrs.  S.  J.  W.,  aged  34  years. 
Had  always  enjoyed  the  best  of  health 
previous  to  her  present  trouble;  was 
suffering  almost  continually  with  neu- 
ralgia (facial),  also  dyspepsia,  and,  as 
she  termed  it,  sick-headache,  nervous 
prostration,  loss  of  sleep,  irregularity  of 
the  bowels,  etc.,  etc.,  so  bad  that  she  was 
compelled  to  keep  her  bed  for  days  at  a 
time.  She  had  employed  many  physicians 
with  only  temporary  benefit.     Upon  ex- 

5  Medical  Record,  1883,  p.  587. 

174 


DISEASES   OF  THE   STOMACH 

amination,  could  detect  no  constitutional 
disturbance  that  could  be  attributed  as 
the  cause  of  her  trouble.  Eut  noticing 
her  foul  breath,  requested  to  examine  her 
teeth,  which  were  found  in  bad  condition, 
several  rotted  do^^Ti,  others  ^\dth  the  gums 
falling  away,  and  so  on.  Requested  her 
to  have  the  offending  members  removed. 
She  objected,  as  it  would  hurt,  and  went 
to  another  physician  for  treatment,  but 
finally  returned,  when,  upon  assuring  her 
that  it  would  be  of  great  help,  she  con- 
sented to  the  operation.  All  the  irritated 
and  irritating  teeth  were  extracted. 
When  asked  if  I  was  not  going  to  pre- 
scribe for  her,  informed  her  I  was  not. 
Three  months  later  she  informed  me  that 
she  had  enjoyed  splendid  health  since  the 
operation." 

Wallis,  of  London,  is  of  the  opinion 
that  oral  sepsis  in  children  has  more  detri- 
mental effect  upon  health  than  does  im- 
proper mastication.^  '*  He  had  considerable 
opportunity  in  the  last  few  years  of  watch- 
ing the  effects  of  oral  sepsis  in  London 
County  Council  school-children.  In  cer- 
tain   schools    there    were    dental    charts 

"British  Journal  Dental  Science.  July,  1910,  p.  591. 

175 


MOUTH   HYGIENE 

showing  the  weights  and  the  average  ages 
of  the  children,  and  these  clearly  showed 
that  the  children  with  the  most  septic 
mouths  were  not  only  below  the  average 
weight  of  their  class,  but  were  below 
the  average  intellectual  status  of  their 
age.  Those  with  the  most  highly  septic 
mouths  were  frequently  two  standards 
below  what  they  ought  to  be  in  accordance 
with  their  age.  With  regard  to  oral 
sepsis,  it  has  been  his  plan  at  the  hospital 
to  have  the  patients  weighed  weekly  after 
wholesale  extractions  of  teeth;  and,  in 
spite  of  their  being  left  unable  to  masti- 
cate their  food,  they  progressively  in- 
creased in  weight,  and  at  the  end  of  a 
few  months  they  had  in  nearly  all  cases 
gained  several  pounds.  That  seemed  to 
show  that  the  really  serious  matter  was 
not  so  much  the  want  of  mastication,  as 
the  fact  that  they  were  constantly  swallow- 
ing the  products  of  decomposition  and 
the  micro-organisms  of  disease." 

Diabetes.  —  Mr.  Peter  Daniel,  sur- 
geon, London,  in  a  discussion  upon  a 
lecture  by  Dr.  Atekerly  on  *'  Observa- 
tion on  the  Condition  of  the  Mouth  in 
1000  Consecutive  Cases  of  Chronic  Dis- 

176 


DISEASES   OF   THE   STOMACH 

eases,"  said:  "Another  important  matter 
was  the  relationship  of  diabetes  to  oral 
sepsis.  A  septic  urethra  or  septic  skull 
was  not  the  same  thing  to  a  patient  as 
a  septic  intestinal  canal;  the  latter  must 
be  of  the  greatest  potency  in  producing 
glycosuria,  which  every  one  agreed  was 
due  to  pancreatic  disease.  Since  1900 
he  had  seen  22  cases  of  complication  of 
diabetes  which  had  come  into  his  hands 
as  a  surgeon,  and  he  had  never  seen  a 
clean-mouthed  man  or  w^oman  among 
them.  In  his  opinion  this  disease  occurred 
most  frequently  in  the  people  who  most 
neglected  the  hygiene  of  the  mouth.  In 
seeking  for  oral  sepsis,  the  majority  ab- 
solutely ignored  the  gums,  crowns,  and 
clasps  of  dentures,  such  data  being  really 
indispensable  to  any  consideration  of  oral 
sepsis." 

It  has  been  the  custom  heretofore  to 
look  upon  pyorrhoea  alveolaris,  which  is 
almost  always  present  in  diabetes,  as  a 
result  of  the  diabetic  condition  rather 
than  a  cause  of  this  disease.  There  is 
no  longer  any  doubt  as  to  the  possibility 
and  the  probability  that  oral  sepsis  is 
productive  of  septic  disease  of  the  pan- 

12  177 


MOUTH  HYGIENE 

creas  by  the  passage  of  septic  organisms 
from  the  intestine  through  the  pancreatic 
duct. 

Toxic  Neuritis.  — ^Dr.  Wm.  Hunter, 
in  his  monograph  on  oral  sepsis,  calls  "  at- 
tention for  the  first  time  to  a  new  and  hith- 
erto unrecognized  effect  of  prolonged  oral 
sepsis,  namely,  toxic  neuritis."  This  dis- 
covery was  made  during  his  studies  of 
pernicious  anaemia,  in  which  he  became 
impressed  with  the  importance  of  oral 
sepsis  in  this  disease.  He  found  the  fre- 
quent occurrence  of  nervous  effects  in 
pernicious  angemia — numbness,  tingling 
in  hands  and  feet,  loss  of  knee-jerk, 
marked  wasting  of  certain  muscles,  and 
local  palsies — were  exactly  duplicated  in 
connection  with  extreme  cases  of  oral 
sepsis,  apart  altogether  from  pernicious 
anaemia.  He  appends  the  notes  of  three 
cases  which  had  recently  come  under  his 
observation.  In  all  of  the  cases  the  ner- 
vous effects  were  very  marked.  In  all 
the  most  intense  condition  of  oral  sepsis 
prevailed,  lasting  for  many  years,  in  one 
case  for  fourteen  years,  and  in  all  the 
cases  immediate  improvement  resulted 
from  a  correction  of  this  condition. 

178 


DISEASES   OF   THE   STOMACH 

The  question  which  naturally  arises  in 
this  connection  is,  may  not  many  of  those 
cases  of  neuritis  in  various  portions  of  the 
body,  the  etiology  of  which  is  so  obscure, 
be  due  to  toxaemia  induced  by  a  long- 
continued  and  intense  condition  of  oral 
sepsis.  The  writer  is  aware  that  his  in- 
terest in  this  particular  subject  of  oral 
sepsis  may  lead  him  to  over-estimate  the 
possibilities  and  dangers  associated  with 
this  condition,  but,  from  the  observation 
and  study  of  the  human  mouth  for  a 
period  of  over  forty-five  years,  the  con- 
viction has  been  gradually  reached  that 
an  unclean,  unsanitary,  unhygienic,  septic 
mouth  is  the  greatest  menace  to  individual 
and  public  health  of  which  he  has  any 
knowledge;  and  that  the  very  fact  that 
this  condition  is  so  common  and  so  gen- 
erally unrecognized  by  the  profession  and 
the  public  generally,  makes  it  all  the  more 
threatening  and  dangerous. 

The  surgeon  and  the  accoucheur  are 
often  at  a  loss  to  account  for  septic  con- 
ditions following  an  operation  or  a  de- 
livery in  which  apparently  ever}'-  precau- 
tion had  been  taken  to  prevent  infection. 
Two  sources  of  infection,  however,  are 

179 


MOUTH  HYGIENE 

almost  never  thought  of, — namely,  the 
mouths  of  the  surgeon  or  the  accoucheur, 
and  their  assistants  present  at  the  opera- 
tion or  delivery,  and  the  mouth  of  the 
patient.  The  mere  covering  of  the  mouth 
and  nose  with  a  piece  of  gauze  is  not  a 
sufficient  protection  against  infection  of 
the  seat  of  operation  when  a  septic 
mouth — a  sometimes  horribly  septic 
mouth — lies  just  behind  it,  emitting  with 
every  breath  or  every  explosive  act  of 
speech  myriads  of  septic  organisms  which 
infect  the  air  surrounding  the  field  of 
operation  and  the  whole  room. 

With  patients  suffering  from  septic 
conditions  of  the  mouth,  entrance  of 
pyogenic  organisms  to  the  blood  and 
Ij^mphatic  streams  is  more  or  less  con- 
stantly taking  place,  thus  endangering 
every  operation  made  upon  the  patient 
through  the  presence  of  septic  organisms 
in  the  blood  and  lymph,  which  lodge  and 
rapidly  multiply  in  tissues  that  have  been 
injured  by  any  cause  whatsoever. 

Xo  surgeon  or  accoucheur  should  ap- 
proach a  patient  until  he  has  rendered 
his  mouth  as  clean  as  possible  by  the  use 
of  the  tooth-brush  and  plenty  of  sterile 
water,  nor  permit  an  assistant  or  a  nurse 

180 


DISEASES   OF   THE  STOMACH 

to  be  present  at  an  operation  or  an 
accouchement  without  having  taken  the 
same  precautions. 

It  is  just  as  important  to  exclude  the 
possibility  of  infection  from  the  unclean 
mouths  of  the  operators  and  the  attend- 
ants as  it  is  to  exclude  the  danger  of 
infection  from  unclean  hands,  towels, 
sponges,  instruments,  ligatures,  etc. 

The  careful  surgeon  before  making  a 
laparotomy  will  take  a  hot  bath,  shampoo 
his  hair,  and  put  on  sterilized  clothing, 
and  require  his  attendants  to  do  the  same. 
Great  care  is  exercised  in  scrubbing  the 
hands,  cleaning  the  finger-nails,  and  ren- 
dering them  as  sterile  as  possible.  As 
an  extra  precaution,  all  wear  sterilized 
rubber  gloves,  and  a  sterilized  cap  over  the 
hair,  and  a  piece  of  gauze  over  the  nose 
and  mouth.  But  how  many  ever  take 
the  same  care  to  render  the  mouth  clean 
before  operation?  Xot  one  in  a  thousand. 
How  many  think  of  the  necessity  of  hav- 
ing the  mouth  of  the  patient  cleaned 
before  an  operation?  Not  one  in  a 
thousand,  if  the  operation  does  not  involve 
that  region. 

No  good  surgeon  or  accoucheur  ever 
forgets  to  have  the  field  of  his  operation 

181 


MOUTH   HYGIENE 

rendered  as  perfectly  sterile  as  soap  and 
water,  the  scrubbing  brush,  and  antisep- 
tics will  make  it.  Yet  how  many  ever 
think  to  examine  the  mouth  for  infections 
that  may  endanger  the  success  of  his 
operation  ?  Or  how  many  accoucheurs  ever 
realize  that  a  septic  mouth  may  endanger 
the  future  health  or  possibly  the  life  of 
his  patient? 

The  mouth  and  teeth  of  every  surgical 
or  lying-in  patient  should  be  examined 
and  such  necessary  dental  service  ren- 
dered  as  will  remove  all  danger  of  septic 
infection  before  the  operation  or  accouche- 
ment takes  place.  It  may  not  always  be 
possible  to  accomplish  this  with  the  surgi- 
cal patients,  but  with  the  obstetrical  cases 
this  service  can  usually  be  rendered.  If 
teeth  have  to  be  extracted,  anaesthetics 
should  be  employed  to  prevent  shock. 

All  operations  upon  the  stomach  or 
intestines,  including  the  appendix,  should 
be  preceded,  when  possible,  by  prelim- 
inary attention  to  the  teeth  and  mouth. 
Sepsis  of  the  oral  cavity  should  be  cor- 
rected before  any  serious  or  important 
operation  upon  the  abdominal  viscera  is 
attempted  if  auto-infection  is  to  be 
prevented. 

182 


CHAPTER  XII. 

THE   PSYCHOLOGICAL   EFFECTS   OF 

DENTAL  AND  ORAL  DISEASES 

AND  SEPSIS. 

One  of  the  marked  s}TQptoms  of  oral 
sepsis  in  children  is  mental  inefficiency, 
and  this  is  always  associated  with  a  more 
or  less  serious  deficiency  in  the  normal 
standards  of  health.  These  children  are, 
as  a  rule,  pale,  listless,  and  under  weight ; 
usually  complaining  of  headache,  fre- 
quently of  toothache,  and  are  subject  to 
periods  of  constipation  and  diarrhoea. 
Many  of  them  upon  a  close  examination 
will  be  found  to  have  enlarged  tonsils,  or 
adenoids,  or  both.  They  are  subject  to 
frequent  catarrhal  attacks  of  the  nasal 
passages  and  throat,  and  not  infrequently 
to  cough  which  persists  all  through  the 
winter  and  spring  months,  thus  materially 
interfering  with  school  attendance  and 
placing  them  in  the  list  of  backward 
children. 

Errors  in  nutrition  and  septic  intoxica- 
tion are  the  prime  causes  of  mental  in- 
efficiency in  children  that  are  born  normal. 
These  errors  may  arise  from  diseases  of 

183 


MOUTH  HYGIENE 

the  teeth  and  the  soft  tissues  of  the  mouth, 
which  make  normal  mastication  an  im- 
possibility, thus  interfering  ^\ath  the  pro- 
cesses of  digestion  and  assimilation,  and 
loading  the  system  with  the  poisons  of 
fermentation  and  putrefaction  of  food, 
which  are  constantly  going  on  in  the 
stomach  and  bowels  under  these  circum- 
stances, thus  preventing  a  proper  and 
healthful  nutrition  and  growth  of  the 
body. 

Similar  conditions  may  arise  from  a 
septic  condition  of  the  mouth,  but  it  would 
be  difficult  to  find  a  septic  mouth  in  which 
dental  decay  and  inflammation  of  the 
gums  and  mucous  membrane  were  not 
present  in  some  of  their  numerous 
manifestations. 

The  adult  mouth  is  sometimes  in  a  very 
septic  condition  when  few  or  no  natural 
teeth  are  present,  but  which  contains 
artificial  dentures  that  are  not  kept  in  a 
sanitary  condition.  Occasionally  an  in- 
dividual will  be  found  wearing  artificial 
dentures  which  have  been  placed  in  the 
mouth  over  a  number  of  decayed  and 
suppurating  roots  of  teeth,  or  an  exten- 
sive bridge  has  been  permanently  set  in 

184 


DENTAL  AND   ORAL   DISEASES 

the  mouth  under  like  conditions.  A  more 
dangerous  proceeding  than  this  could 
hardly  be  imagined.  Some  of  the  most 
serious  cases  of  oral  sepsis  associated  with 
neurasthenia,  depression,  and  melancholy 
that  have  come  under  the  observation  of 
the  writer  have  been  due  to  this  reprehen- 
sible practice. 

Enlarged  tonsils  and  adenoids  are  also 
fruitful  sources  of  malnutrition  and  re- 
tarded growth  in  children.  Proper  oxy- 
genation of  the  blood  is  just  as  important 
in  the  nutrition  of  the  tissues  and  the 
growth  of  the  body  as  are  the  carbohy- 
drates, the  albuminoids,  and  the  mineral 
constituents  of  food.  A  child  with  narrow 
or  more  or  less  occluded  nasal  passages  is 
never  in  a  healthy  or  robust  physical 
condition.  Imperfect  oxygenation  of 
the  blood  is  the  result  of  contracted 
air-passages,  and  this  leads  not  only  to 
imperfect  physical  development  but  to 
imperfect  mental  development  as  well. 
These  children  are  almost  always  dull 
and  sluggish  in  their  mental  processes, 
and  occasionally  give  the  impression  of 
being  mentally  deficient,  when  really  the 
trouble  is  due  to  an  inefficient  elimina- 

185 


MOUTH   HYGIENE 

tion  of  the  waste  products  in  the  blood 
and  its  proper  oxygenation. 

Prof.  James  says,  "  No  mental  modifi- 
cation ever  occurs  which  is  not  accom- 
panied or  followed  by  a  bodily  change." 
It  may  be  said  with  equal  truth  that  no 
important  physical  change  ever  occurs 
without  leaving  its  impress  upon  the  mind. 
A  crooked  back  often  produces  a  crooked 
disposition. 

Burr  says,  *'  Disturbance  in  the  struc- 
ture or  the  functions  of  the  brain  inter- 
feres with  the  play  of  emotion  and  the 
faculty  of  ideation.  Serious  and  long- 
continued  impairment  of  its  nutrition  dis- 
plays itself  in  settled  perversions  of 
thought  and  feeling.  Injury  resulting  in 
cerebral  concussion  may  cause  temporary 
or  permanent  suspension  of  intellection, 
and  defects  in  cerebral  development  are 
accompanied  by  partial  or  complete  ab- 
sence of  the  higher  psychical  processes. 
A  child  is  born  into  the  world  the  structure 
of  whose  brain  is  anatomically  deficient 
or  the  growth  of  which  is  impeded  by 
mechanical  compression.  The  result  is 
idiocy  or  imbecility;  the  development  of 

186 


DENTAL  AND   ORAL  DISEASES 

the  higher  intelligence,  of  judgment,  and 
reasoning  is  impossible." 

Persistent  malnutrition  of  the  body 
sooner  or  later  shows  its  pernicious  effects 
upon  the  processes  of  the  mind.  This  is 
particularly  marked  in  children  who  are 
approaching  the  period  of  pubescence. 
This  is  the  period  when  the  parents  and 
teachers  begin  to  notice  in  the  child  a 
lack  of  concentration  and  interest  in 
study;  perhaps  an  irritability  in  temper 
and  a  disposition  to  contentiouness  is  de- 
veloped, or  the  child  becomes  dull  and 
apathetic,  loses  interest  in  play,  and  per- 
haps shows  more  or  less  distaste  for 
association  with  friends.  The  child  falls 
behind  in  the  school  work,  perhaps  be- 
comes discouraged  and  either  wants  to 
leave  school  or  plays  truant;  or  a  vicious 
temper  may  develop  which  constantly  gets 
the  individual  into  trouble  with  teachers 
and  associates;  or  a  disposition  to  un- 
truthfulness is  developed,  or  to  appro- 
priate, for  individual  use  or  otherwise, 
property  belonging  to  another.  These 
conditions  are  all  the  result  of  a  disordered 
mind  dependent  upon  the  malnutrition 

187 


MOUTH  HYGIENE 

and  septic  poisoning  from  which  the  child 
is  suffering,  and  call  for  medical,  surgical, 
and  dental  aid,  and  sympathy  from  those 
responsible  for  the  up-bringing  of  these 
unfortunate  children.  But  left  to  them- 
selves, without  proper  treatment,  and  con- 
stantly reprimanded  and  punished  for 
their  derelictions,  for  which  they  are  only 
partially  responsible,  they  soon  become 
the  incorrigibles  of  the  school  and  later 
may  enter  the  ranks  of  the  criminal  class. 
The  period  of  pubescence  is  one  of  great 
importance  in  the  development  of  chil- 
dren. During  this  period — in  this  climate 
between  the  ages  of  13  and  15  3^ears — 
the  boy  or  girl  passes  from  childhood  to 
manhood  or  womanhood.  At  this  period 
great  physical  changes  take  place.  The 
organs  of  reproduction  begin  to  assume 
their  function  and  decided  changes  in  the 
personal  characteristics  of  the  individual 
take  place.  It  is  a  most  critical  period 
in  the  life  of  the  boy  or  girl,  a  period 
when  the  gi^atest  wisdom  is  called  for 
upon  the  part  of  parents  and  teachers  to 
guide  them  aright.  It  is  at  this  time  that 
children  ^^dth  neurotic  tendencies  are  apt 
to  develop  undesirable  traits  of  character, 

188 


DENTAL  AND   ORAL  DISEASES 

or  that  those  who  have  inherited  tendencies 
to  unstability  of  mind  are  liable  to  suffer 
from  mental  disease. 

In  those  with  an  unstable  nervous  sys- 
tem —  neurotics  —  chorea,  neurasthenia, 
and  epilepsy  may  be  developed  as  a  re- 
sult of  the  added  nervous  strain  caused  by 
the  establishment  of  new  functions,  and 
the  mental  anxiety  often  manifested  by 
those  who,  through  ignorance  of  the  cause 
for  these  changes  in  their  physical  con- 
dition, are  unable  to  understand  them.  It 
is  positively  wicked  for  parents  or  those 
who  have  the  charge  of  rearing  children 
to  allow  them  to  approach  this  important 
period  in  their  lives  without  preparing 
them  to  understand — of  course  in  a  mod- 
est way,  such  as  a  true  father  and  mother 
will  know  how  to  do — these  changes  in 
bodilv  functions,  and  the  new  desires  and 
aspirations  which  go  with  them. 

The  writer  has  seen  many  cases  of 
chorea  in  growing  children  that  were 
directly  traceable  to  irritation  from  bad 
teeth,  superimposed  upon  an  unstable 
nervous  organization,  or  upon  a  nerv^ous 
system  weakened  by  too  close  applica- 
tion and  too  long  hours  spent  over  their 

189 


MOUTH  HYGIENE 

school  work  and  in  which  they  were  taxing 
their  nervous  energy  to  the  limit  of 
endurance. 

Inattention  in  children  is  always  the 
result  of  nerve  exhaustion. 

A  tired  person,  either  child  or  man,  can- 
not fix  the  attention  upon  any  subject,  no 
matter  how  interesting,  except  for  a  short 
period  of  time.  The  mind  constantly 
wanders  to  other  things,  and  when 
brought  back  to  the  subject  by  an  effort 
of  will  it  cannot  be  held.  Concentration 
seems  impossible.  The  child  who  is 
suffering  from  nerve  exhaustion  inherited 
or  acquired,  in  the  form  of  hysteria  or 
neurasthenia,  is  unable  to  fix  the  attention 
upon  his  studies,  he  lacks  concentration 
of  attention,  and  consequently  he  falls 
behind  the  healthy  child  and  is  soon 
classed  with  the  backward  and  delinquent 
children. 

When  the  writer  was  a  boy  in  school, 
inattention  and  lack  of  concentration  upon 
the  work  in  hand  was  considered  a  "  will- 
ful disobedience/"  and  punished  with 
stripes  from  a  vicious  rattan,  and  this 
with  as  little  justice  as  would  have  been 
the  punishment  of  a  child  positively  ill. 

190 


DENTAL  AND   ORAL  DISEASES 

In  75  per  cent,  of  cases  of  inattention, 
the  child  is  a  sick  child,  for  his  nerves  are 
tired.  He  was  either  born  so  or  he  has 
become  so  through  unhygienic  and  un- 
sanitary  methods  of  living,  and  he  is  no 
more  responsible  for  his  inattention  and 
inability  to  concentrate  his  mind  upon  his 
studies  than  he  would  be  if  sick  from  any 
other  cause.  Children  of  this  character 
are  completely  incapacitated  for  pro- 
longed serious  application  to  any  form  of 
mental  labor. 

American  children  are,  as  a  rule,  en- 
dowed with  a  very  sensitive  nervous  or- 
ganization, and  are  therefore  more  liable 
to  a  nervous  break-down  under  severe 
stress  than  are  children  with  a  more 
phlegmatic  temperament. 

The  correction  of  irregularities  of  the 
teeth  by  mechanical  means  is  often  re- 
sponsible for  the  establishment  of  nervous 
affections  when  the  operation  is  too 
rapidly  performed,  particularly  if  the 
child  possesses  a  highly  endowed  nervous 
organization,  or  is  under  heavy  and  ex- 
acting mental  and  nervous  strain  from 
ill-advised  crowding  in  school  work. 

When  any  severe  strain  is  to  be  placed 

191 


MOUTH   HYGIENE 

upon  the  nervous  endurance  of  a  growing 
child,  like  that  of  correcting  irregularities 
of  the  teeth,  or  expanding  the  dental  arch 
and  superior  maxillary  bones,  to  increase 
the  width  of  the  nasal  passages  so  neces- 
sary in  children  with  arrested  develop- 
ment of  these  bones,  and  also  during 
orthopaedic  operations,  they  should  be  re- 
lieved of  all  school  work  and  all  other  tax 
upon  nervous  energy.  Orthodontists  and 
orthopaedists  are  beginning  to  appre- 
ciate this  fact,  and  children  who  are 
undergoing  these  operations  are  not  so 
often  compelled  to  suffer  such  undue 
nervous  strain  as  formerly. 

Epilepsy  may  also  be  developed  in  the 
same  way  under  like  circumstances.  It 
is  a  question  therefore  of  considerable 
importance  whether  children  who  have 
inherited  a  neurotic  temperament,  with 
a  tendency  to  epilepsy  or  insanity,  should 
ever  be  submitted  to  any  undue  strain  of 
this  kind. 

In  persons  of  neurotic  temperament, 
whether  children  or  adults,  slight  irrita- 
tions are  sometimes  productive  of  grave 
results,  as,  for  instance,  in  the  case  of 
a  young  man  about  20  years  of  age,  who 

192 


DENTAL  AND   ORAL  DISEASES 

came  under  the  observation  of  the  writer 
some  years  ago,  who  had  developed 
symptoms  of  Jacksonian  epilepsy^  and 
was  referred  to  him  for  critical  examina- 
tion of  the  teeth,  but  in  which  no  dental 
disease  was  discernible.  Later  the 
patient  underwent  another  and  more  ex- 
acting general  physical  examination, 
when  the  only  lesion  that  could  be  dis- 
covered was  a  slight  fissure  in  ano — 
fissure  of  the  rectum.  The  cure  of  this 
lesion,  which  had  caused  but  slight  irrita- 
tion and  discomfort,  removed  all  the 
symptoms  of  Jacksonian  epilepsy. 

Professor  Upson  ^  mentions  a  young 
physician  who  was  apparently  a  con- 
firmed neurasthenic,  but  was  perma- 
nently cured  upon  the  discovery  and 
excision  of  a  rectal  ulcer. 


1  Cleveland  Medical  Journal,  1909,  p.  455, 


13 


CHAPTER  XIII. 

THE   PSYCHOLOGICAL   EFFECTS   OF 
PHYSICAL  DEFORMITIES. 

Deformities  of  the  body,  whether  of 
congenital  or  acquired  origin,  often  warp 
the  disposition  of  an  otherwise  correct 
child,  and  later  develop  thoughts,  tenden- 
cies, and  actions  which,  if  neglected,  may 
become  the  forerunners  of  a  perverted, 
vicious,  immoral,  or  criminal  life. 

It  is  a  well-known  fact  that  irregu- 
larities of  the  teeth  and  malformations  of 
the  jaws  are  common  among  the  insane 
and  the  habitual  criminals. 

In  a  joint  paper  upon  "Studies  of  Crimi- 
nals "  ^  prepared  by  Drs.  G.  Frank 
Lydston  and  E.  S.  Talbot,  of  Chicago,  in 
1881,  they  give  the  results  of  the  ex- 
amination of  477  criminals  of  the  habitual 
class,  confined  in  the  State  penitentiary 
at  Joliet,  111.,  of  whom  468  were  males 
and  9  were  females.  Of  the  whole  num- 
ber three  were  Chinese,  18  were  negroes, 


1  Talbot's  Osseous  Deformities  of  the  Head,  Face,  Jaws, 
and  Teeth,  third  edition. 

194 


PHYSICAL  DEFORMITIES 

and  the  remainder  were  whites.  These 
criminals  were  examined  for  the  purpose 
of  ascertaining  how  many  of  them  had 
osseous  deformities  of  the  head,  face,  and 
teeth,  with  the  result  that  63.94  per  cent, 
out  of  this  number  had  some  form  of 
osseous  deformity  of  the  jaws  and  mal- 
arrangement  of  the  teeth.  In  the 
majority  of  the  negroes  the  jaws  were 
well  developed.  One  had  a  partial  V- 
shaped  dental  arch,  one  a  saddle-shaped, 
one  a  V-shaped  arch,  and  in  one  the  left 
body  of  the  lower  jawwas  found  tobemuch 
smaller  than  the  right.  The  bones  of  the 
head  and  face  were  also  well  developed. 

The  three  Chinese  were  all  sub-micro- 
cephalic — small  headed — with  very  small 
jaws,  and  two  of  these  had  saddle-shaped 
dental  arches.  "  It  is  worthy  of  note," 
they  say,  "  that  the  nine  females  exam- 
ined had  large  and  well-developed  jaws 
with  normal  dental  arches." 

The  histories  of  these  cases  "  plainly 
show  at  a  glance  the  physical  degeneracy 
and  often  the  bad  heredity  of  the  sub- 
jects." They  also  invite  attention  to  a 
noteworthy  fact,  that  "  The  cases  which 
most    nearly    approximated    the    normal 

195 


MOUTH  HYGIENE 

type  of  development  were  in  sporadic 
criminals.  The  most  markedly  aberrant 
types  were  found  in  the  imported 
criminals." 

Defects  of  the  palate,  both  in  the  bony 
vault  and  in  the  velum,  are  common 
among  the  defective  and  degenerate 
classes.  Talbot  reports  having  found 
congenital  division  of  the  palate  in  14 
out  of  150  prostitutes,  vicious  implanta- 
tion of  the  teeth  in  62,  anomalies  of  the 
facial  bones  in  64.  In  700  cases  of  in- 
sane patients  confined  in  the  Dunning 
Asylum,  Cook  County,  Illinois,  taken  at 
random,  and  of  whom  430  were  men  and 
270  were  women,  he  found  214  with  ab- 
normal development  of  the  maxillary 
bones. 

Dr.  Henry  J.  Jaulusz,  of  Pittsburgh,^ 
declares:  "The  child  with  poor  teeth 
probably  will  become  the  murderer,  burg- 
lar, or  defective  of  the  future.  The  em- 
bryo criminal  may  be  changed  into  a 
preacher  or  a  great  civic  teacher  by  a 
simple  dental  operation.  The  teeth  of 
children  charged  with  crime  should  be  ex- 
amined by  an  expert,  and  if  found 
defective  they  should  be  put  in  first-class 

a  Oral  Hygiene,  March,  1911,  p.  176. 

196 


PHYSICAL  DEFORMITIES 

order  by  the  State."  He  declared  also, 
"  that  he  could  tell  instantly  by  looking 
at  the  teeth  of  a  child  what  the  criminal 
tendencies  are,  if  any  exist.  ( ?)  After  nu- 
merous tests,  I  am  convinced  that  it  is 
more  important  to  look  after  a  child's 
teeth  than  to  send  him  to  Sunday  School 
or  to  a  reformatory.  The  teeth  of  the 
majority  of  children  are  neither  properly 
cleaned  nor  regulated. 

"It  is  certain  that  abnormal  ideas  will 
take  possession  of  the  child's  mind  under 
these  circumstances.  Take  the  case  of  a 
tooth  that  is  too  close  to  another :  the  life- 
feeding  vessels  are  cut  off.  The  nerves 
become  inflamed.  The  inflammation  pro- 
ceeds along  the  channels  to  the  brain. 
It  is  the  same  with  decayed  teeth.  The 
trouble  goes  to  the  brain  and  creates  ab- 
normal ideas  and  vicious  tendencies. 
Among  sixty-two  deficient  children  I 
examined  in  New  York  schools,  I  found 
all  had  defective  dental  organisms.  Not 
one  of  them  knew  the  Lord's  Prayer,  and 
several  of  them  had  never  heard  of  God. 
They  were  reported  as  cruel  to  animals, 
prone  to  lie,  steal,  and  disobey  their 
superiors. 

197 


MOUTH   HYGIENE 

"  Statistics  gathered  by  Mr.  Howell 
Cheney,  of  the  Connecticut  State  Board 
of  Education,  on  the  relation  existing 
between  physical  defects  of  school-children 
and  their  retardation  in  the  grades,  show 
conclusively  that  children  who  are  re- 
tarded are  almost  invariably  physically 
defective  and  that  among  the  most  im- 
portant defects  are  decayed  teeth."  (Supt. 
Buckley. ) 

Dr.  James  A.  Britton,  the  Detention 
House  j^hysician  of  Chicago,  says,  "  We 
have  every  reason  to  believe  that  an  aching 
tooth  is  frequentlj^  the  first  cause  of  ir- 
regularity in  school  attendance,  and  every 
one  knows  that  irregularity  in  school 
attendance  is  one  of  the  first  steps  towards 
the  juvenile  court." 

The  case  of  JNIorris  Krause,  found  in  the 
report  of  the  tests  made  at  the  Marion 
school  (Part  III),  is  a  remarkable  show- 
ing of  what  may  be  accomplished  by  oral 
hygiene  and  dental  treatment  under  the 
most  adverse  circumstances  that  could  be 
imagined.  This  boy  was  reported  as  the 
terror  of  the  school,  lawless,  selfish,  un- 
trained, incorrigible,  a  truancy  case,  and 
one  year  behind  his  grade.    His  oral  con- 

198 


PHYSICAL  DEFORMITIES 

dition  was  among  the  worst  in  the  class. 
This  boy,  under  proper  hygienic  care  of 
the  mouth  and  the  curing  of  the  diseased 
oral  conditions,  was  changed  to  one  of 
health  and  happiness.  From  the  terror 
of  the  school,  he  became  a  conscientious, 
diligent,  faithful  student,  interested  in  his 
work,  and  made  the  highest  increase  in 
efficiency  of  any  child  in  the  class.  His 
record  shows  an  increase  for  the  first  ten 
months  of  the  test  of  204.3  per  cent. 

Irregular  teeth  together  with  ill  care 
are,  according  to  Dr.  John  F.  Detweiler, 
of  London,  ^  conduciye  to  crime.  He 
says:  "  From  statistics  which  myself  and 
others  haye  gathered,  we  haye  traced  a  re- 
markable percentage  of  crime  among  men 
and  women  under  thirty  years  of  age  to 
bad  teeth.  The  Dentaf  League,  of  Lon- 
don, co-operates  with  the  London  consta- 
bles in  collecting  these  figures,  and  I  haye 
made  many  examinations  of  persons  who 
have  been  arrested. 

"  Teeth  which  are  not  perfectly  aligned 
in  the  mouth  seem  to  make  persons  un- 
reliable and  finally  giye  them  a  criminal 
instinct.    This  discovery  is  in  its  infancy, 

•Oral  Hygiene,  April,  1911. 

199 


MOUTH   HYGIENE 

and  I  believe  many  strides  will  be  made 
along  this  line  in  the  course  of  the  next 
few  years." 

In  speaking  of  the  results  of  the  ex- 
amination and  treatment  of  the  teeth  of 
the  school-children  he  said:  "  It  has  been 
most  successful.  We  have  kept  records 
of  the  patients,  seeing  what  progress  they 
made  before  and  after  treatment.  In 
nearly  every  case,  after  the  teeth  had  been 
treated,  there  was  marked  improvement 
in  the  pupil's  work  at  school," 

Children  with  narrow,  contracted  upper 
jaws  and  irregular  teeth  have  correspond- 
ingly contracted  nasal  passages  and  very 
often  abnormal  growths  in  these  passages, 
such  as  enlarged  turbinates,  thickened 
mucous  membranes,  deflected  septum,  or 
adenoids,  which  further  constrict  the  air- 
passages  and  decrease  the  amount  of  oxy- 
gen entering  the  lungs,  thus  materially 
interfering  with  healthy  growth  of  body 
and  mind,  and  rendering  these  unfor- 
tunate children  nervous,  irritable  in  dis- 
position, and  dull  in  intellect. 

Such  children  by  the  perversion  of  their 
natural  healthy  tendencies,  through  these 
physical   defects,   often   become   morose, 


PHYSICAL   DEFORMITIES 

suspicious,  contentious,  incorrigibles  that 
cannot  be  governed  at  home,  and  who,  if 
sent  to  schools  of  correction,  are  only  made 
more  incorrigible  by  their  treatment,  and 
when  released  are  apt  to  develop  criminal 
tendencies,  if  thev  have  not  already  been 
developed  through  unjust  treatment. 
These  children  do  not  deserve  punishment, 
for  they  are  not  responsible  for  these  tend- 
encies. What  they  need  is  medical,  surgi- 
cal, and  dental  care.  Instead  of  treating 
them  as  criminals  and  confining  them  in 
houses  of  correction,  they  should  be  placed 
in  hospitals  where  these  physical  defects 
may  be  remedied  and  they  be  given  an 
even  chance  in  the  world  to  become  use- 
ful, self-respecting,  honorable  men  and 
women. 

Experimental  work  along  these  lines 
has  already  been  undertaken  by  several 
surgeons  in  various  cities  of  the  United 
States,  the  results  of  which  will  be  looked 
for  with  great  interest.  Judge  De  Lacy, 
of  the  Juvenile  Court  of  Washington, 
D.  C,  has  interested  himself  in  these  ex- 
periments, and  is  doing  all  he  can  to  secure 
a  proper  recognition  of  the  fact  that  many 
children   become   immoral   and   criminal 

201 


MOUTH   HYGIENE 

because  of  some  physical  disease  or  de- 
formity that  can  be  corrected  by  medical, 
surgical,  and  dental  science  and  a  pros- 
pective bad  career  changed  into  a  good 
one. 

Prof.  H.  S.  Upson  reports  the  case  of  a 
thoroughly  bad  young  man,  aged  21  years, 
confined  in  the  Cleveland  Workhouse,  who 
was  cured  of  his  moral  and  mental  ab- 
errations by  the  removal  of  two  impacted 
upper  molars,  two  abscessed  lower  molars, 
and  an  upper  lateral  incisor  which  showed 
evidence  of  absorption  and  marked  ab- 
scess. This  young  man  was  as  a  boy 
unusually  bright,  truthful,  and  honest. 
Was  neurotic  in  temperament,  nervous, 
and  at  times  had  tremors,  when  two  vears 
old  had  a  convulsion,  but  none  since. 
Father's  aunt  was  insane,  but  no  other 
evidences  of  mental  or  moral  aberration 
in  the  family.  Had  a  good  record  in 
study  and  deportment  until  he  entered 
high  school;  was  mischievous,  but  finished 
the  course.  Soon  after,  at  the  age  of  16 
years,  he  began  to  develop  a  penchant  for 
stealing,  burglarized  several  stores,  and 
finally  robbed  a  post-ofi^ice,  for  which 
crime  he  served  two  years  in  a  reforma- 

202 


PHYSICAL   DEFORMITIES 

tory.  At  the  age  of  19  years  he  was 
liberated  from  the  reformatory  and  for  a 
time  thereafter  engaged  in  various  em- 
ployments. Later  was  sentenced  for  60 
days  to  the  reformatory  for  assault  and 
battery,  he  having  "  held  up  "  a  man  on 
the  street.  He  was  restless,  irritable,  and 
contentious;  had  violent  "spells"  when 
he  raved  about  the  house  and  dragged 
his  bedding  to  the  floor  and  slept  upon 
the  bare  springs  of  his  bed.  Sometimes 
he  talked  to  imaginary  persons,  or  would 
hold  his  shoes  in  his  hands  and  talk  to 
them.  Since  the  operations,  he  sleeps 
quietly,  is  seldom  irritable,  laughs  natu- 
rally, is  cheerful  and  happy,  and  has  lost 
all  desire  to  do  wrong. 


CHAPTER  XIV. 

ORAL    SEPSIS    AND    REFLEX    DENTAL 
IRRITATION  AS  CAUSES  OF  DRUNKEN- 
NESS,    NEURASTHENIA,     MELAN- 
CHOLIA,  AND   INSANITY. 

Dipsomania  is  a  neurosis,  usually  in- 
herited. It  is  characterized  by  an  uncon- 
trollable desire  for  indulgence  in  alcoholic 
stimulants,  preceded  by  great  nervous 
depression,  restlessness,  severe  fatigue, 
inattention  to  duties,  and  irritability  of 
temper. 

The  desire  for  indulgence  in  alcoholic 
stimulants  comes  in  storms  or  waves,  and 
in  this  respect  is  a  characteristic  neurosis. 
The  intervals  may  be  long  or  short,  some- 
times several  months  may  intervene 
between  the  storms.  These  people  often 
lead  a  dual  life,  occupying  positions  of 
honor  and  respectability  in  the  commu- 
nities in  which  they  live,  no  one  suspecting 
for  a  long  time  that  they  were  given  to 
periodic  fits  of  the  most  degrading 
debauchery.  They  are  always  very  care- 
ful to  hide  themselves  during  these  times 
in   some    distant    place   where    they   are 

204 


REFLEX  DENTAL  IRRITATION 

unknown  and  not  likely  to  be  discovered. 

Drunkards  are  degenerates,  and  belong 
to  that  class  of  degenerates  that  Maudsley 
and  Ball  designate  as  "  border-land 
dwellers,"— that  is,  dwellers  on  the  border- 
land between  reason  and  pronounced 
madness. 

Morel  says,  "  Degeneracy  is  a  morbid 
deviation  from  an  original  type."  Fere 
says,  "  Vice,  crime,  and  madness  are  only 
distinguishable  from  each  other  by  social 
prejudice." 

Most  degenerates   are  lacking  in  the 
sense  of  morality,   of  right  and  wrong 
and  are  weak  in  will  power.     The  dip- 
somaniac, when  he  is  overtaken  by  one 
of  his  nerve  storms,  is  unable  to  exercise 
his  will  power,  and  loses  all  sense  of  moral 
rectitude,  and  cares  nothing  for  the  right 
and  wrong  of  his  actions,  either  against 
himself  or  others.     He  will  lie,  steal,  or 
even  commit  murder  if  need  be,  to  gratify 
his  insane  desire  for  that  which  will,  for 
the  time  being,  lift  him  out  of  his  awful 
depression  and  give  him  forgetfulness  and 
oblivion.     When  the  storm  is  on,  he  is 
irresponsible  for  his  actions;  he  is  insane. 
Alcoholic  indulgence,  when  carried  to 

205 


MOUTH  HYGIENE 

excess,  is  always  productive  of  physical 
disease.  Chronic  alcoholism  is  generally 
accompanied  with  pathologic  changes  in 
the  blood-vessels,  arteriosclerosis — harden- 
ing of  the  arteries ;  sclerosis  of  the  liver — 
hardening  of  the  liver ;  nephritis — inflam- 
mation of  the  kidneys;  meningitis — in- 
flammation of  the  covering  membranes  of 
the  brain  and  spinal  cord;  and  cerebral 
atrophy — wasting  or  starvation  of  the 
brain-cells.  These  pathologic  changes  re- 
sult in  progressive  mental  conditions,  such 
as  impairment  of  memory,  loss  of  business 
acumen,  disinclination  for  all  mental  pro- 
cesses. Thought  and  speech,  which  were 
originally  refined,  becomes  coarse  and 
vulgar;  his  dress  untidy  or  slovenly. 
When  reasoned  with  about  his  change  in 
habits  he  feels  that  he  is  abused.  Com- 
plains that  his  family  and  friends  have  all 
turned  against  him  and  that  they  are  to 
blame  for  the  misfortunes  that  have  come 
upon  him.  Such  an  individual  is  a  "  bor- 
der-land dweller." 

In  the  preceding  chapter  the  writer  has 
called  attention  to  the  fact  that  de- 
formities of  the  face,  jaws,  and  teeth  are 
very  common  in  the  criminal  classes  and 

206 


Fig.  XXI. 


Impacted  Cuspid,  Upper  Jaw.     Dried  specimen.     (After  Dr.  Cryer.) 


Fig.  XXII. 


Inverted  Upper  Third  Molar.     Living  subject.     (After  Dr.  Cryer.) 


REFLEX  DENTAL  IRRITATION 

the  insane,  also  that  diseased  conditions 
of  the  teeth  and  mouth  and  deformities 
of  the  face  and  jaws  are  common  among 
the  children  who  are  charged  ^\'ith  crime, 
and  that  in  some  cases  the  correction  of 
the  attendant  deformity  or  diseased  con- 
dition has  resulted  in  a  complete  change 
for  the  better  in  both  physical  and  mental 
conditions. 

That  many  cases  of  drunkenness, 
neurasthenia,  melancholia,  and  insanity 
are  due  to  mental  overwork,  business 
worries,  mental  shock,  physical  shock  from 
traumatic  or  surgical  in  jinnies,  child-bear- 
ing, pelvic  diseases,  anemia,  general 
toxaemia  from  sepsis  or  the  continued 
fevers,  specific  disease,  and  heredity,  etc., 
all  will  agree;  but  it  is  a  new  thought 
that  there  may  be  added  to  this  long  list 
of  causes,  oral  sepsis,  the  irritations  and 
perversions  of  functions  due  to  deformities 
of  the  teeth,  face,  and  jaws  and  to  reflex 
dental  irritations  from  malposed  or  im- 
pacted teeth.    ( Figs.  XX,  XXI,  XXII. ) 

Prof.  H.  S.  Upson  found  in  his  investi- 
gations upon  the  relationship  of  dental 
diseases  to  moral  aberration,  that  irrita- 
tions of  practically  a  painless  character 

2a7 


MOUTH  HYGIENE 

were  frequently  responsible,  as  the  sequel 
showed,  for  grave  mental  conditions. 

"  In  the  course  of  an  investigation  upon 
the  subject  >of  impacted  and  otherwise 
diseased  teeth  in  causing  insanity,"  he 
says,  "  I  examined  in  the  winter  of  1908- 
09  eighteen  of  the  younger  inmates  of  the 
Cleveland  Workhouse  with  a  special  view 
to  impaction  of  teeth,  and  incidentally  a 
few  of  the  older  men  for  other  lesions.  Of 
the  eighteen  cases,  ranging  from  18  to 
25  years  of  age,  twelve  showed  multiple 
impactions. 

"  A  number  of  these  were  operated 
upon  and  a  part  of  the  irritation  removed. 
It  was  difficult  to  obtain  histories,  and  in 
most  instances  impossible  to  follow  the 
cases  and  give  them  adequate  relief  from 
the  various  lesions  from  which  they 
suffered.  In  the  course  of  the  investiga- 
tion three  older  patients  were  seen  in- 
cidentally, and  operated  upon  as  a  matter 
of  faint  hope  but  without  much  expecta- 
tion of  a  favorable  result.  The  outcome, 
however,  has  been  unexpectedly  favorable 
in  two  cases;  no  report  has  been  received 
from  the  other  one. 

"  One  patient,  Tom  L.,  had  been  com- 

208 


REFLEX  DENTAL  IRRITATION 

mitted  to  the  institution  ninety-three  times 
during  the  last  thirty  years  for  drunken- 
ness and  fighting.  Although  liquor 
always  made  him  obstreperous,  he  was, 
when  sober,  very  anxious  to  stop  drinking 
and  was  pleasant  and  capable.  Radio- 
graphs showed  abscesses  at  the  roots  of 
two  old  stumps  of  teeth.  These  were  ex- 
tracted in  February,  1909.  Tom  has 
since  told  me  that  before  the  extraction 
he  had  some  toothache,  severe  pain  in  the 
head  and  sleeplessness,  and  in  addition  a 
periodic  craving  for  drink  which  neither 
he  nor  any  one  else  had  ever  connected 
ivith  the  dental  manifestations.  At  the 
last  report  he  had  been  entirely  sober  and 
faithfully  working  for  fifteen  months. 

"  The  other  patient,  a  woman  forty 
years  old,  was  also  unusually  capable  and 
faithful  in  her  sober  moments.  She  had, 
however,  been  committed  twenty  or  thirty 
times  in  the  last  ten  years  for  drunken- 
ness.  She  had  been  sleepless,  had  a  good 
deal  of  headache  in  the  temples  and  in 
the  back  of  her  head,  and  had  suffered 
with  terrible  toothaches  for  several  years 
past.  The  drinking  had  in  her  case  never 
been  associated  by  any  one  with  her  bad 

14  209 


MOUTH  HYGIENE 

teeth.  She  was  well  nourished  and  of 
fairly  good  color.  On  inspection,  the 
nineteen  remaining  teeth  in  her  jaws  were 
all  found  to  be  badly  decayed  and  the 
gums  deeply  ulcerated.  They  were  ex- 
tracted. Following  their  extraction  she 
went  on  one  more  spree,  but  at  last  report 
had  been  entirely  sober  and  at  work  for 
nine  months. 

"  These  patients  appear  to  be  cases  of 
periodic  aberration  caused  by  pain.  There 
is  no  evidence,  however,  to  show  that  the 
craving  for  drink  is  in  such  cases  really 
due  to  any  pain  recognized  as  such  in 
consciousness,  or  localized  in  any  way. 
It  is  rather  the  result  of  vague  but  intense 
emotion,  in  the  form  of  either  unrest,  with 
depression,  or  elation,  with  its  accompany- 
ing lack  of  self-control. 

"  Recovery  in  these  cases  seems  to  have 
been  facilitated  by  an  unusual  original 
endowment,  both  moral  and  mental.  Such 
mentalities,  unless  completely  shattered, 
may  return  to  a  condition  of  stable 
equilibrium  on  the  removal  of  even  a  long- 
continued  irritant  cause  of  aberration. 
The  chances  of  recovery  are  of  course 
much  better  in  early  cases." 

210 


REFLEX  DENTAL  IRRITATION 

This  same  investigator,  in  a  preliminary 
report  made  to  the  Chnical  and  Patho- 
logical Section  of  the  Cleveland  Academy 
of  Medicine  upon  the  Effects  of  Oral 
Sepsis  and  Dental  Irritation  upon  Neu- 
rotics and  the  Insane,  ^  says:  "  I  desire  to 
call  your  attention  to  a  familiar  subject: 
the  melancholy  of  toothache.  The  point 
is  that  the  depression  sometimes  comes 
without  the  ache. 

"  The  principal  symptoms  caused  by 
dental  lesions  are :  First,  pain  in  the  tooth ; 
second,  pain  elsewhere,  especially  in  the 
head;  third,  vasomotor  symptoms,  chills, 
thrills,  flushes,  sweating;  fourth,  insomnia; 
fifth,  melancholy;  sixth,  muscular  twitch- 
ings;  seventh,  fever,  especially  when 
pyorrhoea  is  present;  eighth,  rapid  or  ir- 
regular pulse.  All  of  these  symptoms 
are  important.  If  in  the  absence  of  the 
diagnostic  sign  toothache,  melancholy  may 
run  into  melancholia ;  or  if  sweating,  weak- 
ness, and  flushing,  caused  by  bad  teeth, 
may  constitute  neurasthenia;  or  if  in- 
somnia, unaccompanied  by  dental  pain, 
may  result,  it  becomes  important  to  make 
the  diagnosis  and  remove  the  cause." 

1  Cleveland  Medical  Journal,  vol.  vi,  p.  458. 

211 


MOUTH   HYGIENE 

He  then  outlines  two  cases,  the  first 
one  evidently  a  case  of  septic  irritation 
due  to  a  devitalized  tooth,  and  the  other 
of  reflex  dental  irritation  due  to  an  im- 
pacted third  molar. 

Case  I. — "  A  robust  mechanic,  aged  28 
years.  Three  weeks  before  being  seen, 
had  been  moodily  accosted  by  his  wife  that 
she  believed  she  was  losing  her  mind.  It 
immediately  occurred  to  him  that  he  might 
be  losing  his  mind.  He  slept  little  that 
night  or  the  succeeding  nights,  gave  up 
his  work,  and  spent  his  days  in  fear  of  the 
asylum.  Tonics  and  assurances  were  of 
no  avail.  The  only  lesion  that  could  be 
discovered  was  dental  caries.  The  filling 
of  a  deep  cavity  extending  into  the  pulp 
was  followed  by  prompt  recovery  and  he 
returned  to  work.  At  no  time  had  there 
been  toothache  or  other  pain,  but  dizzi- 
ness and  sweating  had  been  noted. 

Case  II. — "An  unmarried  woman,  aged 
27  years,  a  teacher.  For  a  year  had  been 
profoundly  melancholy,  with  intractable 
insomnia,  delusions  of  various  deadly 
sins,  and  entire  hopelessness  of  recovery. 
Restlessness    was    extreme;    tonics    and 

212 


REFLEX  DENTAL  IRRITATION 

local  uterine  treatment  were  of  no  avail. 
As  a  last  resort  the  teeth  were  examined. 
Thej^  were  apparently  in  perfect  condi- 
tion.   A  radiograph  showed,  however,  an 
impacted  right  upper  third  molar  tooth 
pressing  against  the  second  molar,  a  con- 
dition obviously  capable  of  causing  ir- 
ritation.    The  tooth  was  removed  and  in 
about   a   week   the   symptoms   began   to 
improve.     Recovery  was  complete  in  six 
or  eight  weeks  and  has  persisted  for  six 
months."      He   says    further,    "  The   in- 
ference  is   warranted   that   the   teeth  in 
melancholies,    neurasthenics,    and    those 
afflicted  with  insomnia  should  share  the 
honors  of  a  medical  examination  equally 
with  the  contents  of  the  chest,  abdomen, 
and  pelvis,   and,  when  diseased,   should 
be  cured." 

In  a  more  recent  paper,  ^  "  Painless 
Dental  Disease  as  a  Cause  of  Neuras- 
thenia and  Insanity,"  he  says:  "  The  ob- 
ject of  the  present  paper  is  to  put  on 
record  a  few  observations  made  during 
the  past  two  years  in  a  broad  and  impor- 
tant field,  that  relating  to  dental  diseases 
in  connection  with  nerve  strain  and  with 

*  Cleveland  Medical  Journal,  vol.  viii,  p.  447. 

£13 


MOUTH  HYGIENE 

the  psychoses,  melancholia,  mania,  and 
dementia  precox. 

"  Although  typical  cases  may  occur  in 
which  a  diagnosis  of  one  member  of  this 
nervous  and  mental  group  is  warranted, 
in  many  patients  the  symptoms  blend  in 
such  a  way  that  no  sharp  dividing  line 
can  be  dra^vn.  Most  of  the  mental  cases 
are  nervous,  most  of  the  nervous  cases 
have  a  mental  substratum. 

"  On  the  physical  side  there  is  an  equal 
complexity  of  conditions.  Diseases  of 
the  oral,  abdominal,  or  pelvic  viscera  are 
present  as  an  exciting  cause  in  conditions 
of  insomnia,  simple  depression,  pureh' 
emotional  excitement,  and  in  the  more 
severe  degrees  of  emotional  disorder  with 
or  without  delusions,  so  that  what  one 
considered  normal  emotions  verge  by  im- 
perceptible gradations  into  severe  cases 
of  emotional  and  mental  disorder.  The 
physiologic  and  pathologic  are  one.  It 
is  necessary  to  proceed  from  the  simple 
to  the  complex  in  sifting  these  cases,  in 
order  to  determine  whether  some  or  all 
of  them  are,  in  their  mental  symp- 
toms, dependent  on  underlying  physical 
conditions. 

214 


REFLEX  DENTAL  IRRITATION 

"  One  of  the  simplest  dental  lesions  is 
impaction.  When  a  tooth  is  formed  in 
the  jaw-bone  with  its  axis  wrongly- 
directed,  it  is  often  prevented  by  impact 
against  another  tooth  from  appearing 
outside  the  bone  or  through  the  gum. 
The  result  is  pressure  against  the  peri- 
dental membrane,  in  some  instances 
accompanied  by  severe  toothache  or 
neuralgia.  In  most  cases  no  such  pain 
is  present. 

"  Beginning  with  the  known  fact  that 
an  impacted  tooth  is  not  only  a  stigma — 
deformity — but  a  lesion,  capable  of  caus- 
ing agonizing  pain,  and  the  further  fact 
that  long-continued  intense  pain  may 
cause  delirium  and  insanity,  in  fact,  that 
most  pains  are  associated  with  consequent 
mental  phenomena,  experiment  and  ob- 
servation must  determine  whether  these 
severe  nervous,  mental,  and  moral  symp- 
toms are  due  to  pain  or  may  occur  in 
the  absence  of  pain." 

In  this  connection  he  records  from  his 
private  practice  seven  cases  that  were 
dependent  upon  reflex  dental  irritation 
or  septic  conditions  of  the  mouth. 

Case  I  *'  was  one  of  insomnia  and  mild 

215 


MOUTH   HYGIENE 

melancholia  in  a  merchant  40  years  of 
age.  Trouble  began  fom^  or  five  years 
ago  by  occasional  attacks  of  sleepless- 
ness and  mental  depression.  Two  years 
ago  depression  and  insomnia  became  per- 
sistent and  annoying.  At  times  depres- 
sion was  followed  by  elation  also  attended 
by  insomnia.  These  conditions  were  im- 
proved by  rest  and  became  worse  by  work 
and  worry.  Had  no  headache,  no 
neuralgia,  and  no  toothache,  except 
occasionallv  from  an  ulcerated  tooth, 
which  was  relieved  by  evacuating  the  pus. 
Had  parted  with  three  molar  teeth  during 
the  last  four  years  on  account  of  abscess 
at  the  roots.  Radiogi'aph  showed  left 
upper  third  molar  was  impacted  against 
the  roots  of  the  second  molar,  high  in  the 
jaw-bone.  The  second  molar  was  dead, 
but  showed  no  evidences  of  abscess.  Both 
teeth  were  extracted.  The  roots  of  the 
second  molar  showed  evidences  of  absorp- 
tion from  pressure.  The  patient  made  a 
progressive  recovery.  Sleep  was  better 
two  nights  after  the  operation.  Depres- 
sion has  disappeared  and  the  patient  has 
made  a  practical  return  to  health." 

Case  II  "is  one  of  severe  delusional 
and  suicidal  melancholia  in  a  teacher  27 

216 


REFLEX  DENTAL  IRRITATION 

years  old.  When  first  seen  she  had  been 
profoundly  melancholy  for  more  than  a 
year.  Had  persistent  insomnia  and  many 
delusions,  that  her  mind  was  gone,  had 
never  been  quite  sane,  and  that  she  had 
committed  various  dreadful  sins.  Treat- 
ment by  tonics,  by  suggestion,  change  of 
scene,  and  treatment  of  the  uterus  were 
of  no  avail.  After  a  year  of  useless  effort 
the  teeth  were  examined,  and  found  in 
apparently  normal  condition.  Radio- 
graph showed  an  impacted  upper  third 
molar  which  was  removed  under  anaes- 
thesia. Patient  had  never  in  her  life 
suffered  with  a  toothache  or  any  other 
disease  of  the  teeth  or  jaws.  She  began 
to  sleep  well  within  a  week  or  ten  days 
after  the  extraction  of  the  tooth.  Her 
return  to  normal  health  was  steady,  and 
was  typical  in  the  fact  that  the  delusions 
persisted  longer  than  the  melancholy. 
In  such  patients  it  is  practically  invariable 
that  the  emotional  health  is  recovered 
first  and  the  delusions  are  got  rid  of  after. 
The  only  physical  disease  in  this  case 
was  the  impacted  tooth;  the  other  viscera 
throughout  being  healthy.  The  recovery 
has  been  complete." 

Case  III   "  is  an  example  of  dementia 

217 


MOUTH   HYGIENE 

precox  in  a  man  41  years  of  age.  Was 
well  as  a  boy  and  until  the  age  of  24; 
then  he  began  to  have  periods  of  sleep- 
lessness at  intervals  of  six  months  or  a 
year.  After  a  few  nights  without  sleep, 
would  become  flighty  and  irresponsible. 
Had  some  periods  of  catalepsy,  and  at 
times  ran  away  from  the  institutions  in 
which  he  was  being  treated.  During  the 
intervals  when  he  had  a  fair  amount  of 
sleep  his  mental  condition  was  better,  but 
was  far  from  normal,  being  irritable  and 
of  unhappy  disposition. 

"  Examination  disclosed  an  impacted 
upper  third  molar,  moderately  angled 
against  the  second  molar.  The  third 
molar  was  extracted.  For  several  months 
previously  the  patient  had  been  suffering 
from  insomnia,  but  began  to  sleep  better 
and  to  feel  more  quiet  two  or  three  days 
after  the  operation.  The  gain  in  health 
has  been  progressive  over  several  months, 
and  he  has  since  been  in  a  thoroughly 
normal  condition.  Does  not  sleep  well 
without  sedatives  of  some  kind,  but  has 
lost  his  undue  irritability  and  other 
accompanying  symptoms." 

Case  IV  "  is  one  of  dementia  precox 

218 


REFLEX  DENTAL  IRRITATION 

of  a  severe  and  continuous  type  in  a  girl 
19  years  of  age,  who  has  for  eight  months 
drifted  gradually  into  a  condition  of  men- 
tal aberration.  Her  case  was  marked  by 
an  active  and  persistent  obstinacy.  She 
was  so  restless  that  she  had  to  be  re- 
strained night  and  day.  She  resisted  all 
attempt  at  control ;  her  delusions  were  ex- 
pressed more  and  more  actively  until  her 
talk  became  mere  mutterings.  JNIoaned 
continually  as  if  in  distress,  but  denied 
any  pain  whatsoever.  Was  obstinately 
sleepless  night  after  night.  Loss  of  sleep, 
refusal  to  eat,  and  constant  activity  day 
and  night  had  brought  her  to  a  miserable 
condition  of  pallor  and  emaciation. 
Etherization  was  necessary  in  order  to 
take  radiographs.  A  cuspid  tooth  and  all 
third  molar  teeth  were  found  impacted 
and  removed.  Improvement  began  in  the 
s}Tnptoms  within  two  wxeks  after  the 
operation.  Two  or  three  months  after 
the  operation,  she  had  a  relapse  following 
a  digestive  disturbance,  which  took  the 
form  of  attacks  of  loud  shrieking,  which 
began  early  in  the  morning  after  awaking, 
and  these  attacks  were  continued  for  five 
or  six   weeks.      Improvement,   however, 

219 


MOUTH  HYGIENE 

was  practically  continuous ;  mental  health 
was  established  within  six  or  eight  months 
after  the  operation.  Has  occasional 
severe  headaches.  Has  an  occasional 
sleepless  night.  The  left  lower  molar, 
which  is  dead  and  the  roots  not  filled  to 
the  ends,  and  the  filling  rough  and  over- 
hanging, was  not  treated,  and  it  is  not 
certain  that  there  may  not  be  other  dental 
difficulties  at  this  time." 

Cases  V  and  VI  "  illustrate  the  fact 
that  dental  irritation  of  a  severe  type  does 
not  alwavs  result  in  insanitv,  but  may 
cause  nervous  s\Tnptoms,  neurasthenia,  or 
disturbances  in  the  functions  of  the  in- 
ternal viscera.  These  cases  are  father 
and  son  and  show  heredity  in  nervous 
and  mental  troubles.  The  father  was  a 
man  of  57  years  of  age.  When  13  or  14 
years  old  began  to  show  nervousness  by 
biting  his  nails.  Continued  in  fair  health 
until  26  or  27  years  old,  when  his  digestion 
began  to  suffer.  Had  so-called  nervous 
dyspepsia  in  a  severe  form,  followed  by 
prolapse  and  dilatation  of  the  stomach, 
and  has  had  a  good  deal  of  digestive 
trouble  ever  since.  Radiograph  revealed 
the  right  upper  third  molar  in  an  im- 

220 


REFLEX  DENTAL  IRRITATION 

pacted  position.  Its  removal  was  fol- 
lowed by  prompt  disappearance  of  a  very 
annoying  feeling  of  distress  in  the  head 
which  had  been  present  for  many  years. 
It  was  not  pain,  but  a  maddening  indefi- 
nite pressure,  which  caused  restlessness 
and  strong  impulsion  to  escape  from  an 
intolerable  tension.  Relief  has  been  com- 
plete for  something  over  a  year. 

"  In  the  son,  the  nervous  manifestations 
go  back  to  the  time  when  he  was  four 
years  old,  when  he  had  twitching  of  the 
face  and  the  extremities.  Otherwise  he  had 
been  fairly  well  though  not  robust.  At 
the  age  of  17  years  he  became  consider- 
ably worse,  the  twitching  was  more 
marked  and  digestion  and  circulation  had 
begun  to  fail  perceptibly.  Restlessness 
was  extreme,  but  no  organic  disease  could 
be  found  anywhere  in  the  body.  Radio- 
graphic examination  showed  an  impacted 
right  upper  third  molar  tooth,  almost 
identical  in  appearance  with  the  one  in 
the  case  of  the  father.  In  addition  both 
lower  third  molars  were  impacted  at  a 
high  angle,  and  the  left  upper  third  molar 
was  retained  high  in  the  jaw.  The  third 
molars  were  all  removed,  but  sufficient 

221 


MOUTH  HYGIENE 

time  has  not  yet  elapsed  for  complete 
recovery.  He  is  at  present  convalescent, 
fairly  well,  working  hard,  and  much  less 
nervous." 

Case  VII. — This  is  evidently  a  case  of 
melancholia  of  a  simple  type  due  to 
slovenly  dentistry,  and,  fortunately,  was 
easily  corrected. 

"  The  patient,  a  woman  37  years  old, 
had  always  been  well  until  three  or  four 
years  ago,  when  she  began  to  experience 
a  curious  feeling  in  her  throat  when  she 
swallowed,  but  ^^dthout  pain.  The  feeling 
was  sometimes  better,  sometimes  worse. 
For  several  years  had  been  much  de- 
pressed. Worries  about  her  health  and 
other  things;  has  at  times  been  sleepless. 
Has  had  no  toothache  and  no  headache, 
but  had  one  attack  of  facial  neuralgia 
which  stopped  after  treatment  of  the  dis- 
eased roots  of  a  tooth  in  the  lower  jaw. 
Examination  of  the  teeth  showed  them 
in  fair  condition,  but  with  a  good  many 
ragged  fillings  and  badly  fitting  bridges. 
Upon  the  correction  of  these  conditions 
by  the  dentist,  she  promptly  recovered 
from  her  melancholy,  and  at  last  accounts 
was  almost  free  from  the  hysteric  feeling 
in  her  throat." 

222 


PART  III. 


CHAPTER  XV. 

THE  NATIONAL  ORAL  HYGIENE 
PROPAGANDA. 

The  oral  hygiene  propaganda  recently 
established  in  this  country  by  the  Oral 
Hygiene  Committee  of  the  National 
Dental  Association  should  receive  the 
most  active  and  interested  support  of  our 
general  and  State  governments,  city  and 
county  boards  of  health,  physicians,  den- 
tists, school-teachers,  and  the  public 
generally.  Similar  movements  had  already 
been  established  in  various  sections  of 
Germany  and  England  and  are  doing 
great  good. 

This  movement  not  only  contemplates 
the  establishment  of  free  dental  clinics, 
but  goes  much  deeper  into  the  subjects, 
for  it  proposes  to  take  the  advanced 
position  that  prevention  is  better  than 
cure.  With  this  end  in  view  the  Oral  Hy- 
giene Committee  have  proposed  to  enter 
the  public  schools  and  to  begin  their 
educational  and  practical  vi^ork  with  the 
little  children,  selecting  as  their  first  field 
of  labor  the  schools  in  the  ghetto  districts 

15  225 


MOUTH  HYGIENE 

of  our  large  cities.  In  Cleveland,  Ohio, 
Rochester,  N.  Y.,  New  York  City, 
Chicago,  111.,  Washington,  D.  C,  and 
various  other  large  centres  of  population, 
the  school  boards  and  the  boards  of  public 
health  have  become  interested,  and  in 
some  instances  have  appointed  public 
lecturers  and  dental  inspectors  for  the 
public  schools,  whose  services  are  paid  for 
from  the  public  treasury. 

The  Oral  Hygiene  Committee  and 
several  dental  societies  have  had  lectures 
and  lantern  exhibits  prepared,  which  may 
be  obtained  for  public  education  free  of 
cost.  In  this  way  it  is  hoped  a  general 
interest  may  be  created  in  the  public 
mind  of  the  value  of  oral  hygiene  as  an 
important  public  health  measure,  while 
dental  and  oral  inspection  and  treatment 
will  demonstrate  the  value  of  clean  and 
healthful  mouths  as  factors  in  establish- 
ing and  maintaining  a  healthful  condition 
of  body  and  mind. 

The  Oral  Hygiene  Committee  of  the 
National  Dental  Association,  in  conjunc- 
tion with  the  Oral  Hygiene  Committee 
of  the  State  of  Ohio,  and  the  Cleveland 
Dental  Society,  with  the  co-operation  of 

226 


ORAL  HYGIENE  PROPAGANDA 

the  Cleveland  School  Board,  recently  es- 
tablished, at  the  Marion   School  in  the 
ghetto  of  Cleveland,  a  severe  test  upon 
the  value  of  oral  hygiene  as  a  promoter 
of  general  good  health  and  mental   ac- 
tivity.    The  following  is  a  brief  report 
of  ten  months'  work  in  this  school  with 
a  class  of  twenty-seven  children,   all  of 
whom    were    classed    as    backward    and 
delinquent  children  and  all  of  whom  had 
very  bad  teeth.     In  fact  they  were  chil- 
dren selected  by  the  dental  inspector  as 
having  the  most  unclean  mouths  and  the 
largest  number  of  defective  and  diseased 
teeth  of  all  the  pupils  in  the  whole  school. 
The    dental    inspector    examined    eight 
hundred    and    forty-six    children    at    the 
Marion  school,   and   found  that   97  per 
cent,   were  in  need  of  dental   and  oral 
treatment. 

KEPORT. 
"Cleveland,  O.,  Feb.  18,  1911. 
To  the  Honorable  Members  of  the  Board 
of  Education,  Cleveland,  O. 
Greeting: 

The  National  Dental  Association,  the 
Ohio  State  Dental  Society,  and  the  Cleve- 

227 


MOUTH  HYGIENE 

land  Dental  Society  beg  leave  to  submit 
the  following  report  relative  to  the  work 
undertaken  under  a  resolution  adopted 
by  your  Honorable  Board  on  November 
1,  1909. 

We  regret  our  inability  to  render  a 
report  to  you  upon  the  diate  set  for  the 
same,  but  since  January  1st  our  time  has 
been  devoted  to  securing  statistics  show- 
ing results  of  the  work. 

It  is  also  a  source  of  deep  regret  to 
us  that,  owing  to  the  serious  illness  of 
one  of  the  members  of  our  committee 
who  had  the  principal  part  of  the  work  in 
charge,  we  were  delayed  in  beginning  the 
work  for  about  three  months;  and  as  a 
result  of  this  delay  we  were  unable  to 
complete  all  the  work  we  had  originally 
planned. 

After  securing  the  equipment  and  or- 
ganizing our  working  forces,  the  com- 
mittee became  aware  of  the  fact  that,  with 
the  work  scattered  over  as  broad  a  terri- 
tory as  originally  planned,  it  would  be  a 
very  difficult  matter  to  secure  tabulated 
reports  of  results.  It  therefore  seemed 
wise  that  a  number  of  children,  represent- 

228 


ORAL  HYGIENE  PROPAGANDA 

ing  diiFerent  classes  and  types  of  pupils 
to  be  found  in  the  schools,  be  selected  to 
make  a  careful  and  scientific  test  relative 
to  the  amount  of  improvement  shown  as 
a  result  of  correcting  unhealthy  oral 
conditions. 

In  jNIarion  School  medical  inspection 
had  been  in  progress  something  over  a 
period  of  three  years,  and  whatever  bene- 
fit was  to  be  shown  from  the  same  would 
have  had  sufficient  time  to  affect  the 
records  of  the  children  in  that  school  to 
such  an  extent  that  it  would  not  make 
a  perceptible  difference  in  the  records  of 
the  children.  We  therefore  asked  ]Miss 
O'Neill,  the  principal  of  the  school,  to 
select  a  class  of  forty  children,  twenty- 
seven  of  whom  were  faithful  in  carrying 
out  the  instruction  given  them  relative  to 
the  care  and  use  of  the  teeth.  The  class 
records  of  these  children  were  taken  for 
six  months  preceding  the  time  they  were 
received  for  care,  treatment,  and  instruc- 
tion; and,  in  addition  to  this,  psycho- 
logical tests  were  made  under  the  direc- 
tion of  Prof.  J.  E.  W.  Wallin,  which 
would  show  the  working  efficiency  of  the 

229 


MOUTH  HYGIENE 

child  at  the  time  he  was  received.  These 
tests  included  "  memory,"  "  spontaneous 
association,"  "  addition,"  "  association  by 
opposites,"  and  "  quickness  and  accuracy 
of  perception  "  tests. 

Here  was  found  a  considerable  number 
of  children  who  exhibited  bad  oral  con- 
ditions, backward  physical  development, 
retarded  mental  progress,  and  unruly  or 
immoral  characteristics.  Examination  of 
many  iof  the  children  and  their  school 
records  showed  that  if  the  oral  conditions 
were  not  the  causes  of  the  physical,  men- 
tal, and  moral  backwardness,  there  was 
a  striking  parallelism.  For  the  child 
whose  mouth  was  unclean  and  incapable 
of  proper  mastication  usually  exhibited 
the  conditions  which  the  committee  ex- 
pected. That  is,  bad  oral  conditions,  bad 
physical  conditions,  mental  backwardness, 
and  sulky  or  resentful  or  insubordinate 
moral  attributes  were  all  closely  asso- 
ciated. If  one  started  from  the  other 
end  of  the  chain,  the  result  seemed  to  be 
the  same;  that  is,  the  child  who  was 
notabh^  deficient  physically,  backward 
mentallv,  and  insubordinate  was  found 
to  exhibit  bad  oral  conditions.     Which- 

230 


ORAL  HYGIENE  PROPAGANDA 

ever  end  one  started  from,  the  answer 
was  that  the  conditions  ran  so  closely 
together  that  their  relationships  were 
worthy  of  investigation. 

These  children  were  then  banded  to- 
gether and  instructed  in  the  care  and  use 
of  the  mouth  and  teeth,  and  a  nurse,  ]Mrs. 
Maud  Van  Gastle,  placed  over  them  to 
see  that  they  followed  out  the  instruc- 
tion given  them,  and  test  meals  were 
served  to  show  them  how  to  masticate 
their  food  properly.  The  mouths  of  these 
children  were  then  to  be  put  in  first-class 
condition  and  their  records  taken,  both 
their  class  and  psychological  records,  dur- 
ing the  time  of  treatment  and  for  six 
months  succeeding  treatment.  To  date, 
six  psychological  tests  have  been  made 
and  the  class  records  taken  to  January 
23d;  but  the  teeth  of  all  the  members  of 
the  class  have  not  all  been  put  in  first- 
class  condition.  It  is  our  purpose,  with 
your  permission,  to  make  two  more  psy- 
chological tests  upon  these  children  and 
take  the  school  records  at  the  close  of  the 
school  year,  which  will  be  about  six 
months  after  their  treatment  has  been 
completed,  when  we  expect  to  be  able  to 

231 


MOUTH  HYGIENE 

show  a  very  much  larger  increase  than  we 
have  been  able  to  show  to  date. 

From  the  time  the  clinics  were  opened 
to  date,  the  children  have  been  undergoing 
the  nervous  strain  incident  to  having  den- 
tal work  performed,  therefore,  their 
records  would  not  be  as  good  as  under 
more  favorable  circumstances.  The  ma- 
jority of  the  children  selected  for  this 
class  were  repeaters,  many  of  them  were 
truancy  cases. 

As  to  the  effect  of  our  work  upon  this 
class,  as  relating  to  the  records  of  the  va- 
rious children,  we  beg  leave  to  submit  the 
following  report  or  statement  from  Miss 
O'Neill,  principal  of  the  school,  which 
speaks  for  itself  and  shows  the  value  of 
giving  proper  instruction  in  this  line, 
from  the  educational  side :  " 

"  Marion  School,  Cleveland,  O.,  Feb.  17,  1911. 

Dr.  W.  G.  Ebersole,  Chairman  of  the  Oral  Hy- 
giene Committee  of  the  National  Dental 
Association. 

Dear  Sir: 

I  am  very  glad  to  have  the  opportunity  of 
expressing  my  opinion  of  the  work  of  the  special 
dental  class. 

232 


ORAL  HYGIENE  PROPAGANDA 

As  you  no  doubt  remember,  Dr.  Krejci  ex- 
amined the  mouths  of  the  eight  hundred  and 
forty-six  children  at  Marion  School, 

We  selected  forty  of  the  children  whose  charts 
showed  their  mouths  to  be  in  a  most  serious 
condition. 

Those  forty  children  have  been  under  treat- 
ment from  May,  1910,  till  January  1,  1911. 
Their  teeth  were  put  into  good  condition;  their 
habits  of  eating  were  supervised. 

The  results  far  excel  any  anticipations.  In 
every  instance  the  health  has  improved;  the 
complexion  has  cleared;  and  with  the  attending 
physical  uplift  has  come  a  self-respect  that  made 
them  a  very  desirable  element  in  school;  which 
is  more  than  can  be  said  of  several  of  them  be- 
fore we  began  this  work. 

We  conducted  a  series  of  psychological  tests 
planned  by  an  expert. 

The  conditions  have  been  carried  out  with 
the  utmost  care  and  precision,  and  the  children 
have  almost  uniformly  shown  an  improvement. 

We  believe  it  is  a  most  conclusive  test  of  the 
benefits  that  may  be  derived  from  a  general  care 
and  attention  to  oral  hygiene  during  the  early 
years  of  life. 

The  asset  of  a  good  set  of  teeth  and  correct 
habits  of  eating  and  breathing  will  be  of  im- 
mense value  to  any  child  when  entering  upon 
his  life  career.  We  know  that  to-day  a  vast 
majority  of  our  children  are  not  so  equipped. 

23^ 


MOUTH  HYGIENE 

Trusting  that  some  provisions  for  overcoming 
those  handicaps  will  soon  be  made  in  our  schools, 
I  am, 

Very  respectfully  yours, 
(Signed)  Cordelia  L.  O'Neill, 

Principal  of  Marion  School." 

"  In  support  of  Miss  O'Neill's  state- 
ment, we  beg  to  submit  a  report  or 
statement  from  Dr.  J.  E.  W.  Wallin: 

"Skillman,  N.  J.,  Feb.  24,  1911. 
Dr.  W.  C.  Ebersole,  Cleveland,  O. 

My  Dear  Sir: 

The  study  of  the  effects  of  the  application  of 
proper  operative  and  hygienic  oral  treatment 
upon  the  working  efficiency,  mental  development, 
health,  conduct,  and  regularity  of  attendance  of 
public  school-children,  which  was  begun  in  Cleve- 
land last  May,  is  the  first  attempt,  at  least  in 
this  country,  to  investigate,  by  the  scientific 
methods  of  controlled  experimentation  and  sys- 
tematic clinical  and  pedagogical  observation,  the 
dental  phase  of  the  problem  of  national  human 
conserv^ation.  An  analysis  of  the  tabulated  re- 
sults of  the  serial  psychological  tests,  of  the  prin- 
cipal's scholarship,  and  of  the  records  of  the 
medico-clinical  examination  of  the  pupils  receiv- 
ing dental  treatment,  demonstrates  (1)  the  bene- 
ficence of  the  work  thus  far  accomplished  to  the 
individual  pupils,  in  overcoming  the  retardation 

834 


ORAL  HYGIENE  PROPAGANDA 

of  mental  functioning  due  to  physical  impedi- 
ments; ("2)  the  great  immediate  practical  value 
of  dental  hygiene,  as  a  financial  investment,  to 
the  school  system;  (3)  the  great  contribution 
which  oral  hygiene  will  make  toward  the  con- 
servation of  the  physical  and  mental  vigor  of 
our  people;  and  (4)  the  great  desirability  of  mak- 
ing provisions  for  continuing  the  work  of  inves- 
tigation inaugurated  in  Cleveland,  along  more 
extended  lines.  The  amount  of  improvement  in 
some  of  the  mental  traits  and  capacities,  as 
shown  by  the  successive  psychological  tests,  with 
which  I  have  been  associated,  is  phenomenally 
large  in  some  of  the  cases.  In  one-half  (thirteen) 
of  the  twenty-six  cases,  for  which  I  have  the 
data,  the  average  percentage  of  improvement  in 
the  functions  measured  ranges  from  27  per  cent, 
to  168  per  cent.  In  only  three  cases  is  the  gain 
less  than  three  per  cent,  (two  of  these  being 
negative).  Making  due  allowance  for  natural 
growth,  practice,  and  familiarity,  there  remains 
a  large  margin  of  improvement  which  is  directly 
traceable  to  the  prophylactic,  hygienic,  and 
operative  treatment.  I  feel  persuaded  that  we 
have  here  a  weapon  with  which  to  combat  race 
degeneration  and  pedagogical  retardation  which 
it  would  be  unwise  and  uneconomical  not  to 
utilize  in  increasing  measure. 

Yours  very  truly, 
(Signed)  J.  E.  W.  Wallin, 
Director  of  Laboratory  of  Clinical  Psychology 
in  the  New  Jersey  State  Village  for  Epileptics." 

235 


MOUTH  HYGIENE 

"  Subsequent  to  and  in  support  of  Miss 
O'Neill's  and  Dr.  Wallin's  reports  or 
statements,  we  herewith  submit  a  tabu- 
lated statement  of  the  condition  of  each 
child  before  treatment  and  instruction, 
and  attached  hereto  will  be  be  found  said 
tabulated  report.^ 

We  wish  to  say,  that,  of  the  twenty- 
seven  children  in  this  class,  all  but  two  show 
marked  improvement  in  working  effi- 
ciency— Jacob  Bernstein  shows  a  loss  of 
two-tenths  of  1  per  cent.,  and  Beatrice 
Kramer  a  loss  of  1.8  per  cent.  It  has  been 
found  that,  while  Jacob  Bernstein  shows 
a  slight  loss  from  the  psychological  stand- 
point, his  school  work  shows  an  increase 
of  19  per  cent,  in  working  efficiency. 

The  highest  increase  in  working  effi- 
ciency was  made  by  Morris  Krause,  who 
when  taken  into  the  class  was  lawless, 
selfish,  and  untrained,  a  truancy  case, 
one  year  behind  grade.  This  boy  shows 
an  increase  of  204.3  per  cent. 

All  statements  relative  to  the  members 
of  this  class,  either  as  to  original  condi- 
tions or  final  results,  are  based  upon  ac- 


^  Copies  of  these  reports  may  be  obtained  upon  application 
to  the  Superintendent  of  Public  Schools,  Cleveland,  Ohio. 

236 


ORAL  HYGIENE  PROPAGANDA 

tual  facts  and  existing  conditions,  sup- 
ported by  indisputable  records  and  tests. 
And  all  reports  and  statements  have  been 
rigidly  censored  by  Miss  O'Neill,  princi- 
pal of  Marion  School,  whose  aim  and  am- 
bition has  been  to  see  that  nothing  but 
the  plain  and  unvarnished  facts  be  given 
to  the  world  at  large. 

All  records,  tests,  and  information  from 
which  these  reports  are  taken  are  at  the 
command  of  those  interested,  and  the 
most  careful  and  rigid  investigation  as  to 
the  accuracy  of  the  same  is  invited. 

The  investigation  and  experimentation 
herewith  reported  is  the  first  careful  and 
systematic  effort  made  by  both  the  dental 
and  educational  authorities  to  prove  the 
actual  value  of  healthy  oral  conditions; 
and  the  records  herein  contained  will  be 
the  means  of  working  a  complete  revolu- 
tion in  the  methods  and  manner  of  con- 
ducting and  practising  hygiene  and  sani- 
tation, not  only  in  connection  with  the 
public  schools,  but  other  educational  in- 
stitutions as  well,  and  the  day  is  fast  com- 
ing when  the  "  powers  that  be  "  will  be 
far  more  insistent  upon  a  statement  certi- 
fying  to   the   healthy   condition    of   the 

237 


MOUTH  HYGIENE 

mouth  than  they  will  for  a  statement  that 
the  child  has  been  vaccinated. 

The  average  increase  in  working  effi- 
ciency for  the  class  of  twenty-seven  chil- 
dren is  37.44  per  cent. 

The  data  from  which  these  statistics 
were  secured  have  been  carefully  pre- 
served for  your  inspection  and  considera- 
tion, should  you  desire  to  investigate  the 
correctness  of  this  report. 

Our  committees  wish  to  state  to  your 
honorable  body  that  the  increase  shown 
in  working  efficiency  to  date  has  exceeded 
their  fondest  expectations,  and  we  are 
fully  convinced,  that,  when  the  children 
have  had  an  opportunity  to  work  free 
from  the  handicap  of  having  the  dental 
work  done,  they  will  show  an  increase  of 
over  50  per  cent,  in  working  efficiency 
due  to  the  proper  teaching  of  the  care 
and  USE  of  the  mouth  and  teeth. 

The  value  of  dental  service,  which  in- 
cludes instruction  not  only  in  the  proper 
care  of  the  mouth  and  teeth  but  in  the 
use  of  the  same,  is  shown  when  we  bring 
to  your  attention  the  fact  that  by  ex- 
aminations made  in  June,  1909,  in  four 
representative  schools  in  Cleveland,  it  was 

238 


ORAL  HYGIENE  PROPAGANDA 

found  that  97  per  cent,  of  the  public- 
school  children  were  in  need  of  dental 
care  and  treatment,  and  to-day  we  come 
to  you  with  actual  records  obtained  from 
pupils  in  one  of  these  schools  showing  an 
average  increase  in  working  efficiency 
of  practically  37%  per  cent.,  and  this 
before  treatment  is  completed  or  the  final 
tests  made. 

Dental  caries,  or  decay  of  the  teeth,  is 
the  most  prevalent  disease  of  modern 
civilization,  and  is  just  as  readily  trans- 
ferred from  child  to  child  and  from  adult 
to  adult  as  are  the  organisms  which  pro- 
duce scarlet  fever,  diphtheria,  pneumonia, 
and  tuberculosis;  and  it  is  producing  far 
greater  havoc  than  all  other  diseases  put 
together,  as  the  records  obtained  through 
your  kindness  will  show. 

The  committees  firmly  believe  that  in- 
struction given  in  the  schools  in  the  proper 
care  and  use  of  the  teeth  and  mouth  would 
save  thousands  of  dollars  annually  to  the 
State  and  municipality  in  the  education 
of  their  wards,  and  this  great  saving  too 
would  be  made  in  addition  to  all  expenses 
entailed  in  taking  care  of  the  mouths  of 
those  children  who  could  not  afford  to 

239 


MOUTH  HYGIENE 

have     the     same     done     by    the     dental 
profession. 

To  illustrate  in  a  most  conservative  way 
our  reason  for  making  the  above  state- 
ment, we  will  say  that  we  have  found  that 
97  per  cent,  of  our  public-school  children 
are  in  need  of  care  and  treatment. 
Records  obtained  from  the  experimental 
class  at  Marion  School  to  date  show  an 
average  increase  in  working  efficiency  of 
37.44  per  cent,  from  a  psychological 
stand-point.  These  children  were  selected 
because  they  showed  the  worst  oral  con- 
ditions, and  the  records  were  obtained 
when  the  children  were  undergoing  the 
phj^sical  and  mental  strain  of  having  these 
faulty  oral  conditions  corrected.  The 
dental  work  has  been  completed;  but  the 
period  of  experimentation  does  not  end 
until  June  1st,  when  the  children  will 
have  had  an  opportunity  of  working  for 
a  few  months  free  from  faulty  oral  con- 
ditions and  the  nervous  and  physical 
strain  of  having  such  conditions  corrected. 
When  the  period  of  experimentation  has 
ended,  judging  the  future  by  the  knowl- 
edge and  records  obtained  from  the  past, 
the  committees  feel  that  it  is  reasonably 

240 


ORAL  HYGIENE  PROPAGANDA 

conservative  when  they  say  that  these 
tests  will  show  at  least  50  per  cent,  as 
the  average  increase  in  the  case  of  these 
children. 

With  97  per  cent,  of  the  public-school 
children  in  need  of  care  and  treatment, 
and  with  the  worst  oral  conditions  show- 
ing an  improvement  of  from  37%  per 
cent,  to  50  per  cent,  in  working  efficiency, 
would  it  not  be  conservative  to  consider 
that,  with  all  the  faulty  oral  conditions 
corrected  and  the  mouths  in  first-class 
condition,  there  might  be  an  average  in- 
crease of  at  least  10  per  cent,  in  working 
efficiency  for  all  the  children  in  the 
schools  ? 

If  it  costs  $21.00  per  child  per  year  in 
the  elementary  schools  for  instruction 
alone,  to  get  the  cost  of  educating  the 
child  you  must  add  to  this  cost  the  cost  of 
equipment  and  maintenance.  You  must 
add  to  this  $21.00,  according  to  the  state- 
ment of  Assistant  Superintendent  Bach- 
man,  at  least  25  per  cent.  We  therefore 
find  that  it  costs  us  approximately  $26.25 
a  year  to  educate  a  child  in  the  elementary 
schools.  Then,  from  our  conservative 
estimate  of  10  per  cent,  increase  in  work- 

16  241 


MOUTH   HYGIENE 

ing  efficiency  of  every  child  in  the  public 
schools,  we  find  that  each  child  is  doing 
10  per  cent,  less  than  he  could  do  under 
normal  conditions,  and  we  are  therefore 
paying  10  per  cent,  more  for  the  education 
of  that  child  than  would  be  necessary  un- 
der normal  conditions  to  bring  about  the 
same  results ;  or,  to  look  at  it  from  another 
stand-point,  we  could  do  10  per  cent,  more 
or  better  work  in  the  elementary  schools 
at  the  same  cost.  If  it  is  costing  us  10 
per  cent,  more  to  educate  a  child  per 
year,  then  we  are  paying  $2.62%  per  year 
more  for  each  child  in  our  elementary 
schools  than  would  be  necessary  under 
normal  conditions. 

The  records  of  1909  and  1910  show  a 
registration  of  practically  65,000  pupils 
in  the  elementary  schools,  and  therefore 
upon  the  above  basis  of  figuring  we  would 
show  an  expenditure  of  $170,625.00  a 
year  to  educate  children  handicapped  by 
faulty  oral  conditions ;  but,  in  making  the 
above  estimate,  our  committees  placed 
their  percentage  at  a  figure  which  they 
are  positive  is  less  than  half  of  what 
actual  tests  would  show.  And,  if  we 
double  the  above  amount,  we  find  that  we 

242 


ORAL  HYGIENE  PROPAGANDA 

are  spending  $341,250.00  per  year  to 
overcome  the  handicap  of  faulty  oral  con- 
ditions, most  of  which  can  be  successfully 
overcome  and  prevented  by  proper  in- 
struction in  the  correct  care  and  use  of  the 
mouth  and  teeth. 

The  condition  of  the  mouths  of  the 
school-children  of  this  country,  which  has 
been  growing  worse  instead  of  better,  is 
simply  appalling.  The  loss  in  health, 
strength,  and  beauty  is  most  alarming; 
while  the  seeming  utter  indifference  to 
such  a  condition  on  the  part  of  both  pro- 
fession and  laymen  has  been  most  aston- 
ishing. Such  a  condition  must  be  met 
and  overcome;  and  in  meeting  and  hand- 
ling this  important  problem  the  under- 
signed will  be  glad  to  extend  their  counsel 
and  aid. 

Thanking  your  honorable  body  for  the 
kindnesses  and  courtesies  extended,  we 
beg  to  remain. 

Respectfully  yours, 

OuAL   Hygiene   Committee   of   the 
National  Dental  Association, 
W.  G.  Ebersole,  Chairman'' 

The  final  report  of  this  committee  upon 
the  scientific  tests  made  tlirough  this  class 

243 


MOUTH  HYGIENE 

of  twenty-seven  children  was  presented 
to  the  National  Dental  Association  in  the 
latter  part  of  July  at  Cleveland,  Ohio. 
The  final  psychologic  tests  were  made 
early  in  May  during  the  closing  examina- 
tions of  the  school  year.  It  was  the  pleas- 
ure of  the  writer  to  be  present,  with  a 
number  of  prominent  official  and  educa- 
tional people,  to  witness  these  psychologic 
tests,  and  it  is  our  privilege  to  state  that 
the  tests  were  severe  and  absolutely  fair. 
The  assembled  company  were  invited  to 
take  the  tests  with  the  children,  and 
several  complied,  but  were  in  every  instance 
outdistanced  by  the  class.  To  those 
readers  who  are  interested  in  the  full  de- 
tails of  the  remarkable  showing  of  this 
first  scientific  test  upon  the  value  of  clean 
and  healthful  mouths  and  teeth  and 
proper  use  of  the  teeth  in  mastication,  we 
refer  them  to  the  Transactions  of  the 
National  Dental  Association,  1911,  pub- 
lished by  the  S.  S.  White  Dental  Manu- 
facturing Company,  Philadelphia,  Pa. 

The  following  is  a  brief  summary  of  the 
final  report  of  the  chairman  of  the  com- 
mittee and  of  the  final  report  of  Miss 
O'Neill,  principal  of  the  Marion  School. 

244 


ORAL  HYGIENE  PROPAGANDA 

REPORT    OF    THE    CHAIRMAN. 

Effect  of  the  Oral  Hygiene  Campaign  on 
the  Status  of  Dentistry, 

Finally  your  committee  believes  that  the  facts 
and  records  herewith  presented  comprise  one 
of  the  most  valuable,  if  not  the  most  valuable, 
scientific  discovery  in  the  history  of  dentistry. 

I  want,  personally,  to  say  to  the  president 
and  to  the  members  of  the  National  Dental 
Association,  that  it  was  the  National  oral  hy- 
giene campaign,  as  planned  and  conducted  by 
your  committee,  that  made  it  possible  for  the 
profession  to  receive  the  rank  and  recognition 
accorded  it  during  the  past  year  by  municipal, 
state,  and  national  governments. 

To-night  this  committee  comes  to  you  with 
the  records  obtained  in  carrying  out  a  part 
of  its  policies,  which  places  the  dental  pro- 
fession in  a  position  to  prove  in  dollars  and 
cents  the  actual  value  of  its  services  to  mankind. 

It  shows  that  in  health  conservation  dental 
service  plays  so  important  a  part  that  no  other 
profession  can  equal,  let  alone  excel  it  in  the 
value  of  services  rendered. 

REPORT  OF   MISS   o'nEILI,. 

*'  We  are  to-day  in  the  maelstrom  of  a  move- 
ment for  conservation :  waste  and  loss  are 
measured  from  every  stand-point ;  the  gospel  of 

245 


MOUTH  HYGIENE 

efBcIency  is  being  preached  in  every  line  of 
business.  The  scientific  management  even  of 
the  shovelling  of  ore,  the  laying  of  brick,  or 
the  manufacture  of  machinery  is  studied  until 
the  efficiency  of  the  workman  is  raised  to  the 
highest  degree,  and  loss  of  time  or  labor  re- 
duced to  a  minimum, 

THE  ENVIRONMENT  OF  THE  MODERN  CITY-SCHOOL 
CHILD,    AND    ITS    EFFECTS. 

If  we  allow  ourselves  for  a  moment  to  think 
of  the  rapid  changes  that  are  being  made  in 
our  mode  of  living,  our  methods  of  travel, 
and  our  conduct  of  life,  we  shall  be  impressed 
with  the  necessity  for  utilizing  our  forces  to 
the  greatest  advantage. 

This  necessity  is  very  marked  in  the  field 
of  education.  In  the  year  of  1830  but  5  per 
cent,  of  our  population  in  the  United  States 
lived  in  the  cities ;  to-day  very  close  to  70  per 
cent,  are  so  domiciled.  Think  of  what  that 
means  to  education !  With  95  per  cent,  of 
the  children  out  in  the  open  fields,  breathing 
the  pure  air  of  the  country,  nourished  with 
food  that  had  not  undergone  adulteration,  and 
trained  in  the  varied  pursuits  and  crafts  of  the 
farmer  boy  and  girl  of  that  day,  it  is  not 
surprising  that  little  thought  was  given  by 
the  educator  to  the  physical  welfare  of  his 
pupil.  .  .  . 

246 


ORAL  HYGIENE  PROPAGANDA 

When  a  child  was  close  to  nature,  nature 
took  care  to  correct  the  imperfections  made  by 
unintelligent  civilization.  But  when  outraged 
nature  is  overtaxed  by  the  rush  and  hurry  of 
a  city  existence,  she  refuses  to  cope  with  the 
situation,  and  we  are  rearing  a  race  of  weaklings 
for  future  citizenship. 

The  great  need  of  conserving  the  child  for 
the  nation  appeals  strongly  to  us.  We  cannot 
send  him  back  to  the  country  to  live;  we  must 
deal  with  the  condition  as  it  exists,  hence  the 
training  for  perfect  life  takes  the  place  of  his 
former  simple  life. 

THE   INCREASE    OF    EFFICIENCY   OF    SCHOOL- 
CHILDREN   BY    SCIENTIFIC    MANAGEMENT. 

The  purpose  of  this  paper  is  to  give  evidence 
of  what  may  be  done  to  increase  the  efficiency 
of  the  child  if  a  scientific  management  be 
established. 

An  experiment  along  these  lines  has  been 
made  at  Marion  School.  Marion  School  is 
situated  in  the  congested  section  of  the  city, 
and  its  pupils  come  from  eighteen  city  blocks, 
which  territory  also  supplies  pupils  to  three 
parochial  schools.  The  conditions  might 
furnish  results  that  may  be  found  in  similar 
quarters  in  any  city.  It  has  also  furnished  a 
proof  of  what  may  be  done  in  such  a  community 
by  fostering  the  higher  ideals  of  living. 

247 


MOUTH  HYGIENE 


DENTAL    EXAMINATIONS    OF    THE    MARION 
SCHOOL    CHILDREN. 

In  June  1909  there  appeared  at  our  school 
one  Monday  morning  ten  dentists  and  ten 
nurses  or  attendants,  sent,  by  previous  arrange- 
ment with  the  board  of  education,  to  obtain  an 
idea  of  the  condition  of  the  children's  mouths. 

Inspection  was  made  of  846  children,  and 
a  dental  chart  was  marked  for  each  child.  Out 
of  the  846  examined  just  three  children  were 
found  whose  teeth  were  in  perfect  condition, 
one  a  colored  boy  eleven  years  old,  another  a 
Slavish  girl  of  ten  years  who  had  been  in 
America  about  six  months,  and  one,  an  Ameri- 
can-born child,  aged  twelve,  who  was  of  Russian 
parentage.  One  little  lad  was  found  to  have 
three  abscesses,  two  well  developed  and  the 
third  forming.  (Would  it  be  surprising  if  he 
annoyed  his  classmates  or  refused  to  conform 
to  the  simplest  regulations  of  the  school?) 

Such  a  condition  was  naturally  startling, 
and  we  were  very  much  gratified  to  have  the 
board  of  education  authorize  a  more  specific 
examination  the  next  year. 

Dr.  L.  A.  Krejci  conducted  this  examination 
at  our  school.  Two  classes  of  about  forty 
children  each  were  examined  in  a  day.  Dupli- 
cate charts  were  made,  one  being  kept  by  the 
dentist   and   one    sent   to    the   parents    of   the 

248 


ORAL  HYGIENE  PROPAGANDA 

child.  When  the  examinations  of  the  schools 
were  completed,  Dr.  Ebersole  requested  that 
a  special  class  be  formed  for  observation  and 
study.  The  purpose  was  to  ascertain  what 
effect,  if  any,  would  be  produced  on  the  child 
physically,  mentally,  and  morally  by  attention 
to  the  proper  use  and  care  of  the  oral  cavity. 

EFFECT   OF   MEDICAL   SUPERVISION   AT   MARION 
SCHOOL. 

For  four  years  preceding  the  beginning  of 
the  dental  work,  we  had  at  Marion  School  the 
volunteer  services  of  a  skilful  and  exceptionally 
well-equiped  physician,  who  conducted  the 
medical  inspection  of  our  children.  His  almost 
daily  attention,  aided  somewhat  by  special 
emphasis  on  physical  culture  and  daily  rhyth- 
mic drill,  had  completely  transformed  the  chil- 
dren in  our  school  district.  Though  living 
under  the  same  social,  economic,  and  industrial 
conditions  as  pupils  in  adjacent  school  districts, 
the  children  at  Marion  School  invariably  im- 
pressed visitors,  official  or  otherwise,  as  being 
children  of  a  more  fortunate  type  physically, 
morally,  and  mentally.  Knowing,  therefore, 
what  medical  inspection  had  done  for  us,  I  took 
precautions  before  beginning  the  dental  ex- 
periment to  so  safeguard  our  medical  record 
that  no  credit  would  go  to  the  oral  hygiene 
work  that  rightfully  belonged  to  general  medi- 

249 


MOUTH  HYGIENE 

cal  efforts.  I  was  willing  to  grasp  and  aid 
any  additional  movement  for  the  betterment  of 
the  growing  child,  but  each  resource  must  stand 
on  its  own  merits.  While  I  was  by  no  means 
antagonistic  to  the  movement  for  oral  hygiene, 
I  was  very  jealous  of  the  records  that  we  had 
previously  made  in  improving  our  children. 

METHOD   OF    CONDUCTING   THE   ORAL   HYGIENE 
TESTS  AT   MARION    SCHOOL. 

In  order,  therefore,  that  the  Oral  Hygiene 
Committee  could  not  take  credit  for  work  done 
by  others,  I  took  the  pains  to  secure  written 
statements  of  conditions  from  reliable  people 
who  had  seen  the  work.  I  have  not  needed  to 
use  them,  and  in  fact  have  become  more  con- 
vinced than  those  who  were  trying  to  convince 
me. 

If  this  was  to  be  a  scientific  experiment,  it 
must  be  conducted  with  the  utmost  accuracy 
possible.  All  of  you  who  have  dealt  with 
children  know  that  they  can  be  made  to  perform 
phenomenal  feats  if  skilfully  handled.  It  was 
our  firm  determination  to  keep  in  every  way 
possible  the  efforts  and  environment  of  these 
children  absolutely  normal,  and  have  as  little 
attention  as  possible  directed  to  the  children 
and  to  their  work,  and  no  undue  pressure 
brought  to  bear. 

Our  sessions  were  held  after  school,  when 
all  other  children  had  been  dismissed  for  home. 

%S0 


ORAL  HYGIENE  PROPAGANDA 

Only  what  was  absolutely  necessary  was  ever 
said  in  the  building  concerning  the  work  and 
the  children.  So  little  attention  did  they 
attract  for  the  first  six  months  that  many  of 
the  teachers  in  the  building  did  not  know  who 
of  their  own  pupils  were  in  the  class.  Of 
course  the  distribution  of  five-dollar  gold  pieces 
at  Christmas  time,  of  which  I  will  speak  later, 
made  any  further  quietude  an  impossibility. 
Fortunately  by  that  time  our  work  was  prac- 
tically ended,  and  publicity  could  do  no  harm. 
Then,  again,  we  conducted  the  psychological 
tests  with  as  great  a  degree  of  uniformity  and 
accuracy  as  was  possible.  In  fact  we  can 
publicly  vouch  that  nothing  was  in  any  way 
done  that  would  influence  a  favorable  result. 
What  we  have  attained  have  been  as  nearly 
normal  results  as  it  is  possible  for  human  effort 
to  attain,  and  are  due,  I  believe,  wholly  to  oral 
hygiene. 

With  a  mental  attitude  as  described  we  or- 
ganized our  dental  squad.  With  the  assistance 
of  Dr.  Krejci,  the  examining  dentist,  the  charts 
for  all  the  children,  from  the  fourth  to  the 
seventh  grade  inclusive,  were  looked  over.  We 
did  not  consider  any  eighth-grade  children,  be- 
cause they  were  soon  to  leave  us  for  high  school, 
nor  any  below  the  fourth  grade,  as  their  limited 
abilities  would  make  the  results  of  the  psycho- 
logical tests  practically  valueless  to  us. 

Out   of  the   entire   number   of   charts    forty 

261 


MOUTH  HYGIENE 

were  selected  that  showed  the  greatest  number 
of  defects.  We  made  no  other  condition  in 
the  selection.  It  developed  that  among  the 
forty  whose  charts  showed  the  worst  condition 
were  some  of  our  best  pupils  and  some  of  the 
opposite  element ;  in  fact  it  typically  represented 
the  school.  This  we  deemed  a  most  happy 
choice. 

Conditions  for  the  Marion  School  Dental 
Squad, — The  forty  children  were  assembled 
after  school  on  May  18,  1910.  Dr.  Ebersole 
explained  what  was  required  of  them:  (1) 
They  were  to  have  their  teeth  put  into  perfect 
condition  at  no  expense  to  themselves.  (2) 
They  were  to  brush  their  teeth  carefully  three 
times  a  day.  (3)  They  were  to  masticate  their 
food  properly,  not  using  liquid  with  solid  food. 
(4)  They  were  to  attend  any  and  every  meet- 
ing of  the  class  called,  and  take  from  time 
to  time  psychological  tests,  and  were  to  con- 
form to  regulations  laid  down  by  Mrs.  Van 
Gastle,  who  was  to  act  in  the  capacity  of 
supervising  nurse.  As  a  reward  for  this  co- 
operation each  child  who  faithfully  lived  up  to 
the  requirements  was  to  receive  a  five-dollar 
gold  piece  on  the  Friday  preceding  Christmas. 
To  make  the  reward  more  tangible  and  real, 
Dr.  Ebersole  gave  the  gold  pieces  to  me  in 
the  presence  of  the  children,  and  I  held  them 
in  trust  for  them.     It  was  necessary  that  some- 

852 


ORAL  HYGIENE  PROPAGANDA 

thing  attractive  be  offered  to  have  their  faithful 
co-operation.  It  could  hardly  be  expected  that 
the  juvenile  mind  would  appreciate  the  value  of 
experimental  proofs  of  dental  prophylaxis,  and 
from  a  purely  altruistic  motive  conform  to  a 
series  of  new  and  taxing  regulations,  hence  the 
wisdom  of  the  reward  in  gold.  At  this  time, 
also,  each  child  was  given  a  tooth-brush,  a 
bottle  of  tooth-powder,  and  a  plain  drinking 
glass.  Dr.  Ebersole  thoroughly  explained  the 
process  of  brushing  the  teeth,  which  to  some 
of  the  children  was  something  entirely  new. 
Immdiately  five  withdrew  because  they  would 
not  assume  the  burden.  Of  those  who  remained, 
seven  were  in  the  seventh  grade,  thirteen  in  the 
sixth,  nine  in  the  fifth,  six  in  the  fourth  grades. 
Later,  at  different  times,  three  were  dropped 
from  the  class  because  of  failure  to  attend  the 
tests,  and  five  were  dropped  beause  they  did 
not  keep  their  teeth  clean  and  live  up  to  the 
rules  generally,  leaving  twenty-seven  who  re- 
mained faithful  to  the  end. 

Psychological  Tests. — There  were  a  set  of 
six  psychological  tests  prepared  by  Dr.  Wallin, 
the  psychological  expert.  The  tests  M'ere 
planned  to  ascertain  standards  in  memory, 
accuracy  of  perception,  rapidity  and  accuracy 
of  thought,  and  spontaneity  of  association  and 
differentiation. 

Six   tests   were  given,   two  before  the  work 

253 


MOUTH  HYGIENE 

was  begun  on  the  children's  teeth,  two  while 
the  work  was  being  done,  and  two  a  sufficient 
length  of  time  after  the  mouth  had  been  put 
in  perfect  condition. 

Lessons  in  Mastication  and  Insalivation. — ■ 
Two  special  tests  were  given  in  the  interim 
merely  to  illustrate  to  some  interested  parties 
what  was  being  done.  In  June,  1910,  about 
four  weeks  after  the  beginning  of  the  work, 
a  practical  lesson  in  mastication  and  insaliva- 
tion was  given  by  Mrs.  Van  Gastle,  the  nurse. 
Puffed  wheat  and  cream  were  served  the  chil- 
dren, and  they  partook  of  the  food,  chewed  and 
swallowed  according  to  directions. 

At  this  time  the  process  and  necessity  of 
properly  chewing  the  food  were  carefully  ex- 
plained, and  all  questions  asked  by  the  children 
were  carefully  and  minutely  answered.  This 
started  them  intelligently  in  that  phase  of  the 
work. 

Lessons  in  the  Use  of  the  Tooth-brush. — 
In  September,  1910,  the  children  were  as- 
sembled and  tested  as  to  their  ability  to  brush 
their  teeth.  They  showed  a  vast  improvement 
over  what  they  had  been  able  to  do  in  the 
beginning. 

Test  Dinner. — They  were  then  invited  to  a 
three-course  dinner,  prepared  by  the  school  and 
served  in  the  building.  The  meal  consisted  of 
roast    beef,    potatoes,    tomato    salad,    wafers, 

254 


ORAL  HYGIENE  PROPAGANDA 

grape  jelly,  and  dessert.  After  they  had 
finished  eating,  each  child  was  served  a  glass 
of  water. 

At  that  meeting  one  of  the  boys  said  that  he 
had  been  in  the  habit  of  drinking  six  and  eight 
cups  of  coffee  a  day,  but  since  beginning  to 
chew  as  he  had  been  taught,  he  had  lost  the 
taste  for  coffee,  and  now  sometimes  did  not 
drink  one  cup  in  two  or  three  days.  Most  of 
the  children  took  the  trouble  to  explain  how 
much  better  they  liked  the  new  way  of  eating. 
Many  interesting  and  varied  accounts  were  re- 
lated which  showed  how  thoroughly  they  had 
taken  up  and  were  pursuing  the  prescribed 
course  of  action. 

Operative  Dental  Work, — In  the  meantime 
Drs.  Loupe  and  Moffett  were  treating  the  teeth 
of  each  child.  Regular  appointments  were  made 
and  the  teeth  of  each  child  put  in  good  con- 
dition. Dr.  Chas.  K.  Teter  performed  what 
extractions  were  needed,  and  Dr.  Vamey 
Barnes  did  some  work  in  orthodontia. 

CHARACTER    OF    THE    MEMBERS    OF    THE 
"  DENTAL    SQUAD." 

So  much  for  the  work  done;  now  for  results. 
As  has  been  mentioned  before,  selecting  only 
according  to  the  record  on  the  charts  gave  us 
children  of  various  types.  We  had  some  who 
were  well  behaved,  earnest,  and  bright  children, 

255 


MOUTH  HYGIENE 

and  we  had  some  of  the  most  disobedient,  reck- 
less, and  troublesome  ones.  The  class,  as  it 
first  presented  itself,  notwithstanding  all  that 
had  previously  been  done  for  them,  was  not 
prepossessing.  One  of  the  brightest  and  nicest 
girls  in  the  class  suffered  very  frequently  from 
sick  headache.  Most  of  them  had  sallow,  muddy 
complexions,  and  three  of  them  were  on  the 
point  of  being  taken  into  juvenile  court  for 
truancy.  One  little  boy  was  a  candidate  for 
the  "  boys'  school  "  because  of  incorrigibility. 
He  was  a  nuisance  to  the  school-room  and  a 
terror  in  the  school-yard.  The  others  were 
between  the  two  extremes. 

MENTAL  EFFECTS  OF  THE  "  DENTAL  SQUAD  " 
EXPERIMENT. 

Each  case  was  closely  watched  and  each, 
as  the  work  went  on,  showed  marked  improve- 
ment. The  little  girl  subject  to  sick  headaches 
not  only  was  entirely  cured,  but  her  mother, 
who  followed  the  directions  laid  down  for  the 
little  daughter,  found  relief  from  the  same 
trouble.  The  complexions  cleared,  a  spirit  of 
self-respect  was  manifest ;  truancy,  indifference, 
and  incorrigibility  in  these  children  disappeared. 

In  their  mental  tests  they  have  made  a  very 
considerable  gain,  99.8  per  cent.,  which  comes 
very  close  to  doubling  their  ability. 

The  children   who   needed   the   improvement 

256 


ORAL  HYGIENE  PROPAGANDA 

most  were  the  ones  who  made  the  greatest 
gains.  This  gain  of  99.8  per  cent,  was  shown, 
as  we  have  said,  in  the  psychological  tests.  The 
tests  were  given  one  in  May  and  one  in  June 
of  1910,  the  next  one  in  August,  then  one  in 
September.  The  last  two  were  given  on  the 
4th  and  ITth  of  May,  1911.  The  longest  time 
spent  on  one  phase  of  the  work  during  a  test 
was  less  than  three  minutes,  therefore  the 
pedagogical  principle  of  repetition  could  not 
be  effective  because  of  the  lapse  of  time  between 
each  apperception.  The  mental  picture  was 
wholly  effaced  before  the  next  test  was  given. 

The  increase  in  ability  to  do  the  work  of 
the  psychological  tests  is  due  to  increase  of 
power  in  the  child  rather  than  to  accumulated 
knowledge — a  distinction  that  is  of  great  im- 
portance to  the  educator.  Such  results  ob- 
tained in  the  class-room  distinguish  the  true 
educator   from   the   drill-master. 

The  children's  gain  in  health,  self-respect,  and 
knowledge  of  higher  and  better  living  cannot 
be  marked  in  "  per  cent."  But  who  will  say 
that  it  is  not  equally  if  not  more  valuable? 
And  the  lesson  in  perseverance  and  continuity 
of  purpose  which  they  have  had,  while  not 
adding  anything  to  the  dental  experiment,  can 
be  placed  in  the  column  of  assets. 

Speaking  of  their  perseverance,  we  would  all 
say  that  the  anticipated  reward  of  five  dollars 
17  257 


MOUTH  HYGIENE 

in  gold  was  an  incentive  to  them.  But  the  fact 
is  that  the  five  dollars  was  given  at  the  end  of 
seven  months'  work,  and  during  the  remaining 
seven  months,  or  up  to  the  present  time,  each 
and  every  child  has  been  equally  persevering, 
if  not  more  so,  and  that  with  no  reward  in 
sight  except  what  was  known  to  be  the  real 
benefit  that  comes  to  them  by  faithful  atten- 
tion to  oral  hygiene. 

Just  before  the  close  of  school  last  May  I 
asked  the  children  to  write  me  a  letter  telling 
me  what  they  thought  of  this  experience.  The 
whole  theme  of  their  letters  seemed  to  be  grati- 
tude for  what  was  done  for  them.  We  should 
need  no  stronger  proof  of  the  efficacy  of  the 
work  than  the  affidavits  of  the  children 
themselves. 

One  of  our  school  officials,  after  witnessing 
one  of  the  tests  and  hearing  some  of  the  testi- 
monials, very  aptly  remarked  that  in  this  day 
and  age  we  might  revise  the  expression,  "  Out 
of  the  overflowing  heart  the  mouth  speaketh," 
and  say  instead,  "  Out  of  the  sanitary  mouth 
the  overflowing  heart  speaketh." 

DATA    CONCERNING   INDIVIDUAL    MEMBERS 
OF   THE  SQUAD. 

We  will  now  give  some  specific  data  concern- 
ing the  different  children :  Sol  Katzel,  Frank 
Silverstein,  Jacob  Bernstein,  Joe  Todd,  Lillian 

i58 


ORAL  HYGIENE  PROPAGANDA 

Gottfried,  and  Helen  Wright  did  last  year  in 
twenty-four  weeks  the  same  work  regularly 
done  in  thirty-eight  weeks,  and  were  graduated 
for  high  school  in  February  instead  of  in  June. 

Frank  Silverstein  was  quarantined  on  account 
of  scarlet  fever  in  his  home.  He  helped  nurse 
the  younger  children,  and  every  one  of  the  six 
children  in  the  family  contracted  the  disease 
except  himself.  The  attending  physician 
attributed  his  immunity  to  his  healthy  physical 
condition. 

Helen  Wright  was  weak  and  nervous,  and 
subject  to  frequent  headaches.  Not  only  has 
she  grown  robust,  but  her  headaches  have 
disappeared. 

Sam  Katzel  in  May,  1910,  was  in  the  sixth 
grade.  In  May,  1911,  one  year  later,  he  was 
graduated  from  the  eighth  grade,  having  ac- 
complished two  entire  grades  in  one  year.  He 
had  failed  through  indifference  the  year  before. 

Ben  Dimenstein  at  our  district  athletic  meet 
this  year  won  first  place  in  the  lightweight 
dash  and  first  place  in  standing  broad  jump, 
securing  almost  two-thirds  of  all  the  points 
won  by  the  school.  Last  year,  although  com- 
peting, he  did  not  bring  us  one  point :  he 
says  that  his  success  was  due  to  oral  hygiene. 

Becky  Goldstein  has  had,  I  believe,  the  hard- 
est struggle  in  the  class.  Her  teeth  were  very 
irregular,  the  worst  case  of  malocclusion  I  have 

259 


MOUTH  HYGIENE 

seen.  During  the  winter  her  mother  met  with 
an  accident  and  was  taken  to  the  hospital  for 
an  operation,  leaving  in  Becky's  care  a  baby 
two  weeks  old.  This  baby  was  the  sixteenth  in 
the  family,  and  Becky  the  eldest  daughter. 
For  two  months  Becky,  with  the  help  of  a 
younger  sister  and  with  the  advice  and  help  of 
some  women  of  the  neighborhood,  cared  for  the 
baby,  regulated  the  household,  and  came  to 
school  occasionally  one  or  one-half  day  when 
she  found  some  neighbor  who  would  take  the 
baby  for  a  time.  By  so  doing  she  kept  in 
touch  with  the  work  at  school,  and  was  pro- 
moted with  her  class  in  June.  But  the  most 
remarkable  fact  is  that  during  that  time, 
though  she  had  not  one  unbroken  night's  rest 
on  account  of  her  anxiety  for  the  baby,  she 
retained  her  vigor  and  strength  through  it  all. 

Rose  Lieberman,  Lillie  Semlakowsky,  and 
Lillie  Cohen  have  the  prettiest  sets  of  teeth,  and 
made  a  most  marked  improvement  in  com- 
plexion. Their  improvement  may  be  said  to 
be  sesthetic. 

Annie  Pankuch  had  severe  kidney  trouble, 
and  was  a  fragile,  delicate,  nervous  child.  In 
every  respect  she  was  greatly  improved,  and  is 
sturdy  and  well  to-day. 

Rachel  Somers  led  her  class  in  the  last 
promotions. 

Gussie     Hammerschlag,     Beatrice     Kramer, 

260 


ORAL  HYGIENE  PROPAGANDA 

Bertha  Semlakowsky,  Sarah  Macklin,  Frieda 
Goldman,  Selma  Perlick,  and  Helen  Cohen  have 
shown  improvement  in  scholarship,  behavior, 
health,  and  appearance. 

Issie  Grey's  father  says  that  since  Issie  has 
entered  the  dental  class  he  has  improved  so 
that  he  would  not  give  him  now  for  all  his 
other  children  put  together,  and  we  have  some 
very  nice  children  from  the  Grey  family. 

Hannah  Cohen  has  not  had  the  full  quota 
of  mental  endowments.  She  has  been  in 
America  about  three  years,  has  had  many  diffi- 
culties to  overcome,  and  made  a  gain  of  444.82 
per  cent.,  besides  improving  greatly  physically. 

Ida  Goldman  has  been  the  most  timid  child 
in  the  class.  Her  fear  of  the  dentist  was  such 
that  at  first  I  remained  with  her,  and  held 
her  hands  while  the  dentist  worked.  She  re- 
sponded less  readily,  though  she  made  a  gain 
of  101.83  per  cent. 

Harry  Freeman  and  Abe  Meyer  have  been 
good,  faithful,  steady  workers  and  have  made 
gains,  besides  brightening  up  and  showing 
physical  growth. 

The  last  and  banner  pupil  is  Morris  Krause. 
Morris  had  ideas  peculiarly  his  own  as  to  what 
a  boy's  duties  and  privileges  were.  Those  ideas 
were  so  much  at  variance  w^ith  the  conventional 
standards  that  difficulties  arose,  seemingly  in- 
surmountable at  times.     Since  working  with  the 

261 


MOUTH  HYGIENE 

class  he  has  been  manly,  tractable,  and  does 
not  even  seem  to  have  the  temptations  that 
repeatedly  assailed  him  and  were  almost  the 
means  of  his  down-fall.  The  result  obtained 
for  Morris   alone  was  worth  all  our  efforts. 

THE     LESSON     TAUGHT     EY     ORAL     HY'GIENE. 

I  am  thoroughly  convinced  of  the  efficiency 
of  oral  hygiene.  I  believe  that  if  each  child 
be  taught  to  intelligently  keep  thoroughly  clean 
and  healthy  the  gateway  to  his  system,  the 
mouth,  we  will  have  a  healthier,  more  self-re- 
specting, and  all-around  better  class  of  citizens 
for  the  next  generation.  What  has  been  done 
for  these  twentj'-seven  children  may  be  done 
for  every  child.  If  we  are  called  upon  to 
educate  children  living  in  crowded  city  quarters, 
breathing  varieties  of  harmful  gases  instead  of 
pure  air,  eating  food  adulterated  or  sold  from 
shops  that  display  their  goods  uncovered  and 
exposed  to  the  germs  that  are  scattered  by  that 
portion  of  our  six  hundred  thousand  population 
that  may  chance  to  pass  that  way ;  if,  as  a 
distinguished  physician  says,  the  majority  of 
cases  of  pulmonary  tuberculosis  are  contracted 
through  the  alimentary  canal — then  we  must 
fortify  our  children  by  every  means  in  our 
power; — and  one  of  the  most  effective  guns  on 
our  fortification  is  a  practical  working  knowl- 
edge and  training  in  oral  hygiene." 

262 


ORAL  HYGIENE  PROPAGAXDA 

The  writer  feels  that  this  report  is  a  re- 
markable showing,  and  that  it  should 
challenge  the  attention  and  interest  of 
every  one  in  any  way  connected  with  the 
subjects  of  primary  or  secondary  educa- 
tion,  public  health,   or   good   citizenship. 

In  what  way  can  the  thought  and 
energies  of  our  school  boards,  public 
health  boards,  managers  of  philanthropic 
institutions,  the  State  and  the  public  gen- 
erally be  better  spent  than  in  removing 
these  dangers  to  the  health,  physically, 
mentally,  and  morally,  of  our  school- 
children? 

The  results  of  the  experiments  above 
quoted  prove  beyond  the  shadow  of  a 
doubt  that  if  oral  hygiene  were  taught  in 
our  public  schools,  and  the  teeth  of  the 
children  properly  cared  for,  at  public  ex- 
pense when  necessary,  but  insisted  upon 
when  parents  were  able  to  bear  the  cost, 
great  advantage  would  accrue  to  the 
State. 

This  advantage  would  be  of  the  greatest 
moment  economically,  as  it  would  mater- 
ially lessen  the  expense  of  education,  re- 
duce the  number  of  the  sick  and  the 
mentally  incompetent  that  become  a  pub- 

263 


MOUTH   HYGIENE 

lie  charge,  also  lessen  the  number  of 
criminals  and  insane  persons  that  have  to 
be  taken  care  of  by  the  State,  and  greatly 
assist  in  elevating  the  physical,  mental, 
and  moral  stamina  of  the  nation.  ''  The 
health  of  the  people  is  the  supreme  law/' 


^V^fer 


^^/. 


COLUMBIA  UNIVERSITY  UBRAWES  IhsLSIX) 

RK  305  M35  1916  C.2^ 

Mout 


iiiniiilliiiii'i 

2002370069 


